Provider Demographics
NPI:1659126605
Name:PEDRAZA DIAZ, GRETCHEN (RBT)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:PEDRAZA DIAZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16950 W DIXIE HWY APT 120
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3726
Mailing Address - Country:US
Mailing Address - Phone:786-660-6308
Mailing Address - Fax:
Practice Address - Street 1:16950 W DIXIE HWY APT 120
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3726
Practice Address - Country:US
Practice Address - Phone:786-660-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24341191106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty