Provider Demographics
NPI:1598408577
Name:LINARES DIAZ, ROSELI
Entity Type:Individual
Prefix:
First Name:ROSELI
Middle Name:
Last Name:LINARES DIAZ
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 1:11005 W OKEECHOBEE RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4239
Mailing Address - Country:US
Mailing Address - Phone:786-452-3996
Mailing Address - Fax:
Practice Address - Street 1:11005 W OKEECHOBEE RD UNIT 102
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4239
Practice Address - Country:US
Practice Address - Phone:786-452-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-162546106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113695100Medicaid