Provider Demographics
NPI:1679441356
Name:DIAZ, ANNIEL (RBT)
Entity type:Individual
Prefix:
First Name:ANNIEL
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 1:15520 SW 136TH ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3087
Mailing Address - Country:US
Mailing Address - Phone:786-783-9902
Mailing Address - Fax:
Practice Address - Street 1:15520 SW 136TH ST UNIT 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3087
Practice Address - Country:US
Practice Address - Phone:786-783-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-25
Last Update Date:2025-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT25480465106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty