Provider Demographics
NPI:1083485684
Name:DIAZ COSSIO, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:DIAZ COSSIO
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 1:12037 ASHTON MANOR WAY APT 212
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7016
Mailing Address - Country:US
Mailing Address - Phone:407-776-0714
Mailing Address - Fax:
Practice Address - Street 1:12037 ASHTON MANOR WAY APT 212
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7016
Practice Address - Country:US
Practice Address - Phone:407-776-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-321147106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician