Provider Demographics
NPI:1689340937
Name:DIAZ PEREZ, MERCEDES (RBT)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:DIAZ PEREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W 54TH ST APT 117
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2121
Mailing Address - Country:US
Mailing Address - Phone:786-286-2639
Mailing Address - Fax:
Practice Address - Street 1:1900 W 54TH ST APT 117
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2121
Practice Address - Country:US
Practice Address - Phone:786-286-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-124619106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician