Provider Demographics
NPI:1265221527
Name:AVILES GOMEZ, DIANA ROSA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ROSA
Last Name:AVILES GOMEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3473 BELLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7155
Mailing Address - Country:US
Mailing Address - Phone:407-749-3049
Mailing Address - Fax:
Practice Address - Street 1:150 3RD ST SW STE 109
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2980
Practice Address - Country:US
Practice Address - Phone:863-272-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician