Provider Demographics
NPI:1013376052
Name:DIAZ, YIRA
Entity Type:Individual
Prefix:
First Name:YIRA
Middle Name:
Last Name:DIAZ
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 1:115 CLUNIE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1001
Mailing Address - Country:US
Mailing Address - Phone:917-640-1282
Mailing Address - Fax:
Practice Address - Street 1:115 CLUNIE AVE APT 2
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1001
Practice Address - Country:US
Practice Address - Phone:917-640-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor