Provider Demographics
NPI:1922230275
Name:DIAZ, YESENIA ENID (MA)
Entity Type:Individual
Prefix:MS
First Name:YESENIA
Middle Name:ENID
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5459 VINELAND RD
Mailing Address - Street 2:4208
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7659
Mailing Address - Country:US
Mailing Address - Phone:813-420-3874
Mailing Address - Fax:
Practice Address - Street 1:5459 VINELAND RD
Practice Address - Street 2:4208
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-7659
Practice Address - Country:US
Practice Address - Phone:813-420-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health