Provider Demographics
NPI:1790513042
Name:DIAZ, ANTHONY ALCIDES (RBT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ALCIDES
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 1:11261 SW 238TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 ANTILLA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3301
Practice Address - Country:US
Practice Address - Phone:305-567-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-352616106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician