Provider Demographics
NPI:1104475367
Name:DIAZ HERNANDEZ, YENISLEY
Entity type:Individual
Prefix:
First Name:YENISLEY
Middle Name:
Last Name:DIAZ HERNANDEZ
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 1:10055 SW 215TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3035
Mailing Address - Country:US
Mailing Address - Phone:786-422-3005
Mailing Address - Fax:
Practice Address - Street 1:7867 GRAND CANAL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2262
Practice Address - Country:US
Practice Address - Phone:786-422-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician