Provider Demographics
NPI:1922755024
Name:FELIPE DIAZ, KENIA
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:FELIPE DIAZ
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 1:6016 NW 16TH CT
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-2711
Mailing Address - Country:US
Mailing Address - Phone:305-748-1204
Mailing Address - Fax:
Practice Address - Street 1:6016 NW 16TH CT
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-2711
Practice Address - Country:US
Practice Address - Phone:305-748-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-156724106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician