Provider Demographics
NPI:1720639867
Name:LIMA ROBAINA, DIANELYS
Entity Type:Individual
Prefix:
First Name:DIANELYS
Middle Name:
Last Name:LIMA ROBAINA
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 1:15320 SW 106TH TER APT 1124
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2760
Mailing Address - Country:US
Mailing Address - Phone:305-263-0412
Mailing Address - Fax:
Practice Address - Street 1:15320 SW 106TH TER APT 1124
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2760
Practice Address - Country:US
Practice Address - Phone:305-263-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102914500Medicaid