Provider Demographics
NPI:1235644865
Name:SANTOS, DIANA ROSA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ROSA
Last Name:SANTOS
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 1:7376 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1409
Mailing Address - Country:US
Mailing Address - Phone:786-239-6738
Mailing Address - Fax:
Practice Address - Street 1:7376 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1409
Practice Address - Country:US
Practice Address - Phone:786-239-6738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician