1265953863 NPI number — RAIZA DIAZ PEGUERO BEHAVIOR TECHNICIAN

Table of content: RAIZA DIAZ PEGUERO BEHAVIOR TECHNICIAN (NPI 1265953863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265953863 NPI number — RAIZA DIAZ PEGUERO BEHAVIOR TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ PEGUERO
Provider First Name:
RAIZA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BEHAVIOR TECHNICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265953863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7550 FUTURES DR STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32819-9096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-730-7983
Provider Business Mailing Address Fax Number:
407-985-3678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2105 HARTWOOD MARSH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711-5389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-720-5067
Provider Business Practice Location Address Fax Number:
407-459-1741
Provider Enumeration Date:
07/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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