Provider Demographics
NPI:1295318244
Name:DIAZ BLANCO, NOELIA M
Entity type:Individual
Prefix:
First Name:NOELIA
Middle Name:M
Last Name:DIAZ BLANCO
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 1:1639 PALERMO DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1906
Mailing Address - Country:US
Mailing Address - Phone:954-540-3137
Mailing Address - Fax:
Practice Address - Street 1:8040 NW 155TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5880
Practice Address - Country:US
Practice Address - Phone:305-827-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst