Provider Demographics
NPI:1346910536
Name:DIAZ-IGLESIAS, ODALYS
Entity Type:Individual
Prefix:
First Name:ODALYS
Middle Name:
Last Name:DIAZ-IGLESIAS
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 1:8430 SW 8TH ST APT 601
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4112
Mailing Address - Country:US
Mailing Address - Phone:786-285-8713
Mailing Address - Fax:
Practice Address - Street 1:8430 SW 8TH ST APT 601
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4112
Practice Address - Country:US
Practice Address - Phone:786-285-8713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-139277106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician