Provider Demographics
NPI:1285107888
Name:DIAZ, ADRIANA (MED BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MED BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-3823
Mailing Address - Country:US
Mailing Address - Phone:928-318-2135
Mailing Address - Fax:928-318-2134
Practice Address - Street 1:1060 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-3823
Practice Address - Country:US
Practice Address - Phone:928-318-2135
Practice Address - Fax:928-318-2134
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000688103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst