MEDICARE: EVOLVEKIDSABA LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1891642898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVEKIDSABA LLC

Provider Business Mailing Address
First Line	:	4000 N STATE ROAD 7 STE 302C
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-4863
Country	:	US
Telephone Number	:	786-231-0363
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 N STATE ROAD 7 STE 302C
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-4863
Country	:	US
Telephone Number	:	786-231-0363
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YESENIA DIAZ
Credential	:	BCBA
Telephone Number	:	786-231-0363

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “EVOLVEKIDSABA LLC ” Practice Location

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