MEDICARE: GRACIELA PROENZA DIAZ

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	RBT-20-117479	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972125011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACIELA PROENZA DIAZ

Provider Business Mailing Address
First Line	:	627 SW 21ST AVE APT 4
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-3347
Country	:	US
Telephone Number	:	305-767-5664
Fax Number	:

Provider Business Practice Location Address
First Line	:	627 SW 21ST AVE APT 4
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-3347
Country	:	US
Telephone Number	:	305-767-5664
Fax Number	:

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

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	05/12/2020

Similar Medicare Providers

1588558423 — ACCESS MEDICAL GROUP OF MIAMI MEDICARE, LLC
Practice Location Address:

701 NW 27TH AVE
MIAMI, FL
33125-3012

Practice Phone: 786-744-1900
Practice Fax: 305-760-4141

1093760076 — DR. STANLEY FROHLINGER D.M.D.
Practice Location Address:

960 ARTHUR GODFREY RD STE 400
MIAMI BEACH, FL
33140-3347

Practice Phone: 305-532-4419
Practice Fax:

1124234083 — SOUTH DEERING RETIREMENT HOME, INC.
Practice Location Address:

9730 COLONIAL DR
MIAMI, FL
33157-3347

Practice Phone: 786-293-2816
Practice Fax:

1932735230 — RUJAYME JIMENEZ PEREZ
Practice Location Address:

6701 SW 62ND AVE APT 111
SOUTH MIAMI, FL
33143-3347

Practice Phone: 305-200-9848
Practice Fax:

1215545322 — DR. DAVID AARON CUPO
Practice Location Address:

960 ARTHUR GODFREY RD STE 400
MIAMI BEACH, FL
33140-3347

Practice Phone: 305-914-2876
Practice Fax:

1023700416 — SHOSHANA BARISHANSKY DMD
Practice Location Address:

960 ARTHUR GODFREY RD STE 400
MIAMI BEACH, FL
33140-3347

Practice Phone: 305-842-3119
Practice Fax:

Directions to “ GRACIELA PROENZA DIAZ ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.