Provider Demographics
NPI:1912883588
Name:DIAZ HERNANDEZ, CRYSTIAN
Entity type:Individual
Prefix:
First Name:CRYSTIAN
Middle Name:
Last Name:DIAZ HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 ACAPULCO DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3605
Mailing Address - Country:US
Mailing Address - Phone:786-424-3621
Mailing Address - Fax:
Practice Address - Street 1:2331 ACAPULCO DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3605
Practice Address - Country:US
Practice Address - Phone:786-424-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-25-461011106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician