Provider Demographics
NPI:1497229884
Name:AGUERO DIAZ, ALVARO FERNANDO (RBT)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:FERNANDO
Last Name:AGUERO DIAZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2468 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4380
Mailing Address - Country:US
Mailing Address - Phone:786-334-4104
Mailing Address - Fax:
Practice Address - Street 1:7235 SW 24TH ST STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1451
Practice Address - Country:US
Practice Address - Phone:786-452-0257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-13140106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician