Provider Demographics
NPI:1164131785
Name:MORALES DIAZ, BETILEIDY DE LA
Entity Type:Individual
Prefix:
First Name:BETILEIDY
Middle Name:DE LA
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 1:6815 N 47TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-1807
Mailing Address - Country:US
Mailing Address - Phone:813-453-3032
Mailing Address - Fax:
Practice Address - Street 1:6815 N 47TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-1807
Practice Address - Country:US
Practice Address - Phone:813-453-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician