Provider Demographics
NPI:1710768023
Name:DIAZ RAMOS, MAYDEL (RBT-23-303309)
Entity Type:Individual
Prefix:
First Name:MAYDEL
Middle Name:
Last Name:DIAZ RAMOS
Suffix:
Gender:F
Credentials:RBT-23-303309
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 SW 12TH LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2396
Mailing Address - Country:US
Mailing Address - Phone:510-599-7849
Mailing Address - Fax:
Practice Address - Street 1:1616 SW 12TH LN
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2396
Practice Address - Country:US
Practice Address - Phone:510-599-7849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-303309106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician