Provider Demographics
NPI:1679132559
Name:DIAZ, EVELIO E (RBT)
Entity type:Individual
Prefix:
First Name:EVELIO
Middle Name:E
Last Name:DIAZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 NW 17TH AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-6191
Mailing Address - Country:US
Mailing Address - Phone:786-458-4769
Mailing Address - Fax:
Practice Address - Street 1:3380 NW 17TH AVE APT 304
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-6191
Practice Address - Country:US
Practice Address - Phone:786-458-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-76036103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst