Provider Demographics
NPI:1265953863
Name:DIAZ PEGUERO, RAIZA (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:RAIZA
Middle Name:
Last Name:DIAZ PEGUERO
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7550 FUTURES DR STE 105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9096
Mailing Address - Country:US
Mailing Address - Phone:407-730-7983
Mailing Address - Fax:407-985-3678
Practice Address - Street 1:2105 HARTWOOD MARSH RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5389
Practice Address - Country:US
Practice Address - Phone:407-720-5067
Practice Address - Fax:407-459-1741
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician