Provider Demographics
NPI:1982206348
Name:ROSALES DIAZ, BEATRIZ A
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:A
Last Name:ROSALES 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 1:27981 SW 134TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8257
Mailing Address - Country:US
Mailing Address - Phone:754-610-1420
Mailing Address - Fax:
Practice Address - Street 1:27981 SW 134TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8257
Practice Address - Country:US
Practice Address - Phone:754-610-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician