Idileidy Diaz-Gutierrez
Individual provider Active NPI Behavior Technician · Miami, FL
NPI 1104578764 · NPPES record last updated Jan 24, 2022
Key facts
- NPI
- 1104578764
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- 19-95078 (FL)
- Practice address
- 16225 SW 110TH Ave
Miami, FL 33157-2819 - Phone
- (305) 741-8995
- NPI assigned
- Jan 24, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19-95078 | FL | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 19-95078 | FL | Yes |
Addresses
Primary practice location
16225 SW 110TH Ave
Miami, FL 33157-2819
Mailing address
16225 SW 110TH Ave
Miami, FL 33157-2819
Phone (305) 741-8995
Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.