Provider Demographics
NPI:1144075300
Name:DIAZ GOMEZ, ARQUEL (RBT)
Entity type:Individual
Prefix:
First Name:ARQUEL
Middle Name:
Last Name:DIAZ GOMEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25130 SW 114TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6329
Mailing Address - Country:US
Mailing Address - Phone:786-872-2195
Mailing Address - Fax:
Practice Address - Street 1:25130 SW 114TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6329
Practice Address - Country:US
Practice Address - Phone:786-872-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-337868106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician