Provider Demographics
NPI:1922762830
Name:DIAZ, BARBARA SUSANA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:SUSANA
Last Name: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 1:2412 ROLLING BROAK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7452
Mailing Address - Country:US
Mailing Address - Phone:407-509-4746
Mailing Address - Fax:
Practice Address - Street 1:2412 ROLLING BROAK DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7452
Practice Address - Country:US
Practice Address - Phone:407-509-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician