Provider Demographics
NPI:1700496130
Name:DIAZ MARTIN, ALICIA DE LA CARIDAD (RBT)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:DE LA CARIDAD
Last Name:DIAZ MARTIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13936 SW 90TH AVE APT CC206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8972
Mailing Address - Country:US
Mailing Address - Phone:786-261-8375
Mailing Address - Fax:
Practice Address - Street 1:13936 SW 90TH AVE APT CC206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8972
Practice Address - Country:US
Practice Address - Phone:786-261-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician