Provider Demographics
NPI:1235911413
Name:DIAZ ALONSO, YUSLEIDY
Entity Type:Individual
Prefix:
First Name:YUSLEIDY
Middle Name:
Last Name:DIAZ ALONSO
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 1:11119 HANNAWAY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3908
Mailing Address - Country:US
Mailing Address - Phone:786-217-2601
Mailing Address - Fax:
Practice Address - Street 1:11119 HANNAWAY DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3908
Practice Address - Country:US
Practice Address - Phone:786-217-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-295948106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician