Provider Demographics
NPI:1134485196
Name:DIAZ, YAMILE
Entity Type:Individual
Prefix:
First Name:YAMILE
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 1:10286 NW 9TH STREET CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3220
Mailing Address - Country:US
Mailing Address - Phone:786-991-7278
Mailing Address - Fax:305-757-4465
Practice Address - Street 1:3271 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4141
Practice Address - Country:US
Practice Address - Phone:786-991-7278
Practice Address - Fax:866-726-0526
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FL1-21-53553103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker