Provider Demographics
NPI:1043890684
Name:BOZADA DIAZ, MERARY
Entity Type:Individual
Prefix:
First Name:MERARY
Middle Name:
Last Name:BOZADA DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ROYAL PALM RD APT 106
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4641
Mailing Address - Country:US
Mailing Address - Phone:786-521-9270
Mailing Address - Fax:786-279-0915
Practice Address - Street 1:160 ROYAL PALM RD APT 106
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-4641
Practice Address - Country:US
Practice Address - Phone:786-521-9270
Practice Address - Fax:786-279-0915
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-118618106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician