Provider Demographics
NPI:1811107402
Name:DIAZ, DANAI (MA)
Entity type:Individual
Prefix:
First Name:DANAI
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DANAI
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA-MS
Mailing Address - Street 1:9101 TILLINGHAST DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1625
Mailing Address - Country:US
Mailing Address - Phone:813-369-2501
Mailing Address - Fax:
Practice Address - Street 1:9101 TILLINGHAST DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1625
Practice Address - Country:US
Practice Address - Phone:813-369-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-48161103K00000X
FL19-84125106S00000X
FLMA39212225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist