Provider Demographics
NPI:1871291542
Name:PUJOLS, DIANA ROSA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ROSA
Last Name:PUJOLS
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 1:17650 NW 67TH AVE APT 1404
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5814
Mailing Address - Country:US
Mailing Address - Phone:305-333-3473
Mailing Address - Fax:
Practice Address - Street 1:17650 NW 67TH AVE APT 1404
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5814
Practice Address - Country:US
Practice Address - Phone:305-333-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician