Provider Demographics
NPI:1699389940
Name:DIAZ CANO, IRIS
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:DIAZ CANO
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 1:10245 SW 24TH ST APT D364
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2572
Mailing Address - Country:US
Mailing Address - Phone:305-497-7901
Mailing Address - Fax:
Practice Address - Street 1:175 FONTAINEBLEAU BLVD STE 2K4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7014
Practice Address - Country:US
Practice Address - Phone:786-558-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician