Provider Demographics
NPI:1285372953
Name:FEBLES DIAZ, JANY DEL LORETO
Entity type:Individual
Prefix:
First Name:JANY
Middle Name:DEL LORETO
Last Name:FEBLES DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W PARK DR APT 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3902
Mailing Address - Country:US
Mailing Address - Phone:786-922-7415
Mailing Address - Fax:
Practice Address - Street 1:415 W PARK DR APT 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3902
Practice Address - Country:US
Practice Address - Phone:786-922-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL114081500106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician