Provider Demographics
NPI:1972012789
Name:GOMEZ DIAZ, YAIRIN
Entity Type:Individual
Prefix:
First Name:YAIRIN
Middle Name:
Last Name:GOMEZ 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 1:1803 SW 107TH AVE APT 2102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7371
Mailing Address - Country:US
Mailing Address - Phone:786-223-7991
Mailing Address - Fax:
Practice Address - Street 1:1803 SW 107TH AVE APT 2102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7371
Practice Address - Country:US
Practice Address - Phone:786-223-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician