Provider Demographics
NPI:1366162661
Name:DIAZ-QUINTANA, REBECA (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECA
Middle Name:
Last Name:DIAZ-QUINTANA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:REBECA
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:9370 SW 72ND ST STE A213
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5452
Mailing Address - Country:US
Mailing Address - Phone:305-951-0122
Mailing Address - Fax:305-938-0762
Practice Address - Street 1:9370 SW 72ND ST STE A213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5452
Practice Address - Country:US
Practice Address - Phone:305-951-0122
Practice Address - Fax:305-938-0762
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7602103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist