Provider Demographics
NPI:1447145792
Name:DIAZ, BRYAN (RBT)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2619
Mailing Address - Country:US
Mailing Address - Phone:305-986-1516
Mailing Address - Fax:
Practice Address - Street 1:20335 W COUNTRY CLUB DR APT 1410
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1622
Practice Address - Country:US
Practice Address - Phone:786-523-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-443288106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician