Provider Demographics
NPI:1770001604
Name:CALDERON SANCHEZ, DIANA GIMENA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:GIMENA
Last Name:CALDERON SANCHEZ
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 1:8835 NW 149TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1315
Mailing Address - Country:US
Mailing Address - Phone:786-474-8813
Mailing Address - Fax:
Practice Address - Street 1:8835 NW 149TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-1315
Practice Address - Country:US
Practice Address - Phone:786-474-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician