Provider Demographics
NPI:1932868254
Name:AVILA GRAVERAN, DIAMARIS
Entity Type:Individual
Prefix:
First Name:DIAMARIS
Middle Name:
Last Name:AVILA GRAVERAN
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 1:991 W 51ST PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3427
Mailing Address - Country:US
Mailing Address - Phone:786-604-7246
Mailing Address - Fax:
Practice Address - Street 1:991 W 51ST PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3427
Practice Address - Country:US
Practice Address - Phone:786-604-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-143618106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician