Provider Demographics
NPI:1871634139
Name:DIAZ-VEGA, YASELLYN (DC)
Entity Type:Individual
Prefix:DR
First Name:YASELLYN
Middle Name:
Last Name:DIAZ-VEGA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:YASELLYN
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1732 RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2157
Mailing Address - Country:US
Mailing Address - Phone:585-865-3991
Mailing Address - Fax:
Practice Address - Street 1:1732 RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2157
Practice Address - Country:US
Practice Address - Phone:585-865-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010954-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY152836ANOtherPREFERRED CARE
NY7697600OtherAETNA
NYC10954-8WOtherWORKMEN'S COMPENSATION
NY7697600OtherAETNA
NYBA0313Medicare ID - Type UnspecifiedMEDICARE