Provider Demographics
NPI:1871380352
Name:DIAZ CHACON, OLGA ELENA
Entity type:Individual
Prefix:
First Name:OLGA ELENA
Middle Name:
Last Name:DIAZ CHACON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 GAGE PL APT 109B
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2326
Mailing Address - Country:US
Mailing Address - Phone:305-796-7728
Mailing Address - Fax:
Practice Address - Street 1:6315 GAGE PL APT 109B
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2326
Practice Address - Country:US
Practice Address - Phone:305-796-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-421267106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician