Provider Demographics
NPI:1588017982
Name:DIEGUEZ CANTALLOPS, DELKIS
Entity type:Individual
Prefix:
First Name:DELKIS
Middle Name:
Last Name:DIEGUEZ CANTALLOPS
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 1:5048 W 12TH LN # D19
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3183
Mailing Address - Country:US
Mailing Address - Phone:786-312-9778
Mailing Address - Fax:
Practice Address - Street 1:5048 W 12TH LN # D19
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3183
Practice Address - Country:US
Practice Address - Phone:786-312-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-57956106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician