MEDICARE: MELISSA DIAZ PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	106E00000X	Assistant Behavior Analyst	02314692	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-21-150121	OTHER	FL	BACB
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831782168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA DIAZ PEREZ

Provider Business Mailing Address
First Line	:	1280 W 35TH ST
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-2918
Country	:	US
Telephone Number	:	512-483-1027
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 W 35TH ST
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33404-2918
Country	:	US
Telephone Number	:	512-483-1027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	11/09/2023

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Directions to “ MELISSA DIAZ PEREZ ” Practice Location

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