Provider Demographics
NPI:1861030876
Name:DIAZ CARRAZANA, ANA L
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:L
Last Name:DIAZ CARRAZANA
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 1:27767 SW 133RD PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6854
Mailing Address - Country:US
Mailing Address - Phone:786-291-7116
Mailing Address - Fax:
Practice Address - Street 1:27767 SW 133RD PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6854
Practice Address - Country:US
Practice Address - Phone:786-291-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-121825106S00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician