Provider Demographics
NPI:1518531060
Name:PADILLA ALONSO, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:PADILLA ALONSO
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 1:10090 NW 80TH CT APT 1546
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2244
Mailing Address - Country:US
Mailing Address - Phone:786-545-6538
Mailing Address - Fax:
Practice Address - Street 1:10090 NW 80TH CT APT 1546
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-2244
Practice Address - Country:US
Practice Address - Phone:786-545-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-154250106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician