Provider Demographics
NPI:1518702190
Name:DIAZ DE LEON, YVETTE (LMT)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:DIAZ DE LEON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N MESA ST # A2-87
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1538
Mailing Address - Country:US
Mailing Address - Phone:915-241-2485
Mailing Address - Fax:
Practice Address - Street 1:3800 N MESA ST # A2-87
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1538
Practice Address - Country:US
Practice Address - Phone:915-241-2485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT140743225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist