Provider Demographics
NPI:1770331068
Name:DIAZ, YANELA
Entity type:Individual
Prefix:
First Name:YANELA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14762 SW 82ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1558
Mailing Address - Country:US
Mailing Address - Phone:305-901-9591
Mailing Address - Fax:
Practice Address - Street 1:14762 SW 82ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1558
Practice Address - Country:US
Practice Address - Phone:305-901-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF04240735363LF0000X
FLRBT-20-116288106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily