Provider Demographics
NPI:1457659641
Name:DIAZ, YANETSY A
Entity Type:Individual
Prefix:
First Name:YANETSY
Middle Name:A
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 1:1051 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-4315
Mailing Address - Country:US
Mailing Address - Phone:786-370-0576
Mailing Address - Fax:
Practice Address - Street 1:1051 E 19TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-4315
Practice Address - Country:US
Practice Address - Phone:786-370-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA62249OtherMASSAGE THERAPIST