Provider Demographics
NPI:1932980141
Name:TOMAS DIAZ, JOHANIA SR (RBT)
Entity Type:Individual
Prefix:
First Name:JOHANIA
Middle Name:
Last Name:TOMAS DIAZ
Suffix:SR
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 SW 128TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5457
Mailing Address - Country:US
Mailing Address - Phone:786-760-7413
Mailing Address - Fax:
Practice Address - Street 1:6049 SW 128TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5457
Practice Address - Country:US
Practice Address - Phone:786-760-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-294828106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty