Provider Demographics
NPI:1316778244
Name:PADRON DIAZ, BARBARA ESTRELLA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ESTRELLA
Last Name:PADRON 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 1:20715 SW 120TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-5319
Mailing Address - Country:US
Mailing Address - Phone:954-815-0210
Mailing Address - Fax:
Practice Address - Street 1:20715 SW 120TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-5319
Practice Address - Country:US
Practice Address - Phone:954-815-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-363106106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician