Provider Demographics
NPI:1710658133
Name:DIAZ, YANA MARIA VISSIA DULAY
Entity Type:Individual
Prefix:
First Name:YANA MARIA VISSIA
Middle Name:DULAY
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 1:21500 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7038
Mailing Address - Country:US
Mailing Address - Phone:818-742-8045
Mailing Address - Fax:
Practice Address - Street 1:10700 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-3133
Practice Address - Country:US
Practice Address - Phone:818-831-0058
Practice Address - Fax:818-831-1749
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197606826310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility