Provider Demographics
NPI:1568173961
Name:COBAS PADIERNA, DIANA (BCABA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:COBAS PADIERNA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S PALM VILLAS WAY
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-1084
Mailing Address - Country:US
Mailing Address - Phone:786-970-2543
Mailing Address - Fax:
Practice Address - Street 1:816 COTTON BAY DR W APT 1303
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-9131
Practice Address - Country:US
Practice Address - Phone:786-970-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL02214091106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst