Provider Demographics
NPI:1942783972
Name:FERNANDEZ DIAZ, VANELYS IVETTE
Entity Type:Individual
Prefix:
First Name:VANELYS
Middle Name:IVETTE
Last Name:FERNANDEZ 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 1:1084 CAPITOL HILL CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6428
Mailing Address - Country:US
Mailing Address - Phone:787-428-4755
Mailing Address - Fax:
Practice Address - Street 1:1084 CAPITOL HILL CT
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6428
Practice Address - Country:US
Practice Address - Phone:787-428-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker