Provider Demographics
NPI:1285208132
Name:RAMOS, DIANA ROSA LEON (BACB626962)
Entity Type:Individual
Prefix:
First Name:DIANA ROSA
Middle Name:LEON
Last Name:RAMOS
Suffix:
Gender:F
Credentials:BACB626962
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 NW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5427
Mailing Address - Country:US
Mailing Address - Phone:786-314-0724
Mailing Address - Fax:
Practice Address - Street 1:6807 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2116
Practice Address - Country:US
Practice Address - Phone:786-280-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB626962106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician