Provider Demographics
NPI:1144739665
Name:DIAZ ENCINOSA, BARBARA MARISOL (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:MARISOL
Last Name:DIAZ ENCINOSA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:MARISOL
Other - Last Name:DIAZ ENCIONSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:15259 SW 71ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1643
Mailing Address - Country:US
Mailing Address - Phone:786-510-0637
Mailing Address - Fax:
Practice Address - Street 1:15259 SW 71ST LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1643
Practice Address - Country:US
Practice Address - Phone:786-510-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018069600Medicaid