Provider Demographics
NPI:1962242545
Name:FERNANDEZ DIAZ, ANDREINA DEL PILAR
Entity type:Individual
Prefix:
First Name:ANDREINA
Middle Name:DEL PILAR
Last Name:FERNANDEZ 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 1:39339 GREENMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-6777
Mailing Address - Country:US
Mailing Address - Phone:407-914-8703
Mailing Address - Fax:
Practice Address - Street 1:39339 GREENMEADOW DR
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6777
Practice Address - Country:US
Practice Address - Phone:407-914-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-318993106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician