Provider Demographics
NPI:1053788851
Name:DIANA BARRENECHE, INC
Entity type:Organization
Organization Name:DIANA BARRENECHE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BARRENECHE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:305-965-2016
Mailing Address - Street 1:102 NE 2ND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3908
Mailing Address - Country:US
Mailing Address - Phone:561-674-2859
Mailing Address - Fax:561-571-0316
Practice Address - Street 1:7100 W CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-674-2859
Practice Address - Fax:561-571-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1546231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS0035OtherBLUE CROSS BLUE SHIELD
FL003416500Medicaid
FLIJ412AOtherMEDICARE PTAN