Provider Demographics
NPI:1235665019
Name:FERNANDEZ DIAZ, DELIO JESUS
Entity Type:Individual
Prefix:
First Name:DELIO
Middle Name:JESUS
Last Name:FERNANDEZ DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10421 OLD CUTLER RD APT 107
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1721
Mailing Address - Country:US
Mailing Address - Phone:786-806-0308
Mailing Address - Fax:
Practice Address - Street 1:13301 SW 132ND AVE UNIT 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6190
Practice Address - Country:US
Practice Address - Phone:786-713-5553
Practice Address - Fax:786-713-5559
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-20-10934106E00000X
FL1-21-48302103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst