Individual
JESSICA DIAZ-BALSECA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14211 SW 83RD ST, MIAMI, FL 33183-3930
(786) 493-9587
Mailing address
14211 SW 83RD ST, MIAMI, FL 33183-3930
(786) 493-9587
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103404200
—
FL
Enumeration date
08/29/2018
Last updated
10/28/2019
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