Provider Demographics
NPI:1558171983
Name:TRIANA DIAZ, ANDRO
Entity type:Individual
Prefix:
First Name:ANDRO
Middle Name:
Last Name:TRIANA DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14871 SW 104TH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2437
Mailing Address - Country:US
Mailing Address - Phone:786-820-8882
Mailing Address - Fax:
Practice Address - Street 1:14871 SW 104TH ST APT 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2437
Practice Address - Country:US
Practice Address - Phone:786-820-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician