Provider Demographics
NPI:1184071821
Name:DIAZ, MIRIAM ARIANA
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ARIANA
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 1:6841 NW 173RD DR
Mailing Address - Street 2:Q-102
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5574
Mailing Address - Country:US
Mailing Address - Phone:786-280-8820
Mailing Address - Fax:
Practice Address - Street 1:6841 NW 173RD DR
Practice Address - Street 2:Q-102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5574
Practice Address - Country:US
Practice Address - Phone:786-280-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-51673103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst