Provider Demographics
NPI:1942940671
Name:DIAZ SANCHEZ, LISIBET
Entity type:Individual
Prefix:
First Name:LISIBET
Middle Name:
Last Name:DIAZ SANCHEZ
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 1:4971 WEYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2259
Mailing Address - Country:US
Mailing Address - Phone:818-795-0558
Mailing Address - Fax:
Practice Address - Street 1:4971 WEYMOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-2259
Practice Address - Country:US
Practice Address - Phone:818-795-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-209240106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician