Provider Demographics
NPI:1114778404
Name:MORALES DIAZ, DAYLEN
Entity Type:Individual
Prefix:
First Name:DAYLEN
Middle Name:
Last Name:MORALES 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 1:5381 W 1ST AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2701
Mailing Address - Country:US
Mailing Address - Phone:786-675-8635
Mailing Address - Fax:
Practice Address - Street 1:5381 W 1ST AVE UNIT B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2701
Practice Address - Country:US
Practice Address - Phone:786-675-8635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-196239106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician