Provider Demographics
NPI:1215725312
Name:ROMAGOZA DIAZ, EDUARDO ENRIQUE
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ENRIQUE
Last Name:ROMAGOZA DIAZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7004
Mailing Address - Country:US
Mailing Address - Phone:786-810-1945
Mailing Address - Fax:
Practice Address - Street 1:10401 SW 53RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7004
Practice Address - Country:US
Practice Address - Phone:786-810-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-427025106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty