Provider Demographics
NPI:1952167991
Name:DIAZ, BRYAN RENE
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:RENE
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6870 SW 44TH ST APT 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4762
Mailing Address - Country:US
Mailing Address - Phone:786-413-7135
Mailing Address - Fax:
Practice Address - Street 1:6870 SW 44TH ST APT 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4762
Practice Address - Country:US
Practice Address - Phone:786-413-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician