Provider Demographics
NPI:1205670973
Name:DIAZ LEON, CAMILA
Entity type:Individual
Prefix:
First Name:CAMILA
Middle Name:
Last Name:DIAZ LEON
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 1:3390 S DOUGLAS RD APT 102
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2761
Mailing Address - Country:US
Mailing Address - Phone:786-726-2649
Mailing Address - Fax:
Practice Address - Street 1:3390 S DOUGLAS RD APT 102
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2761
Practice Address - Country:US
Practice Address - Phone:786-726-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician