Provider Demographics
NPI:1720838691
Name:CERON, DIANA P
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:P
Last Name:CERON
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 1:12460 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6002
Mailing Address - Country:US
Mailing Address - Phone:786-270-8927
Mailing Address - Fax:
Practice Address - Street 1:12460 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6002
Practice Address - Country:US
Practice Address - Phone:786-270-8927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician