Provider Demographics
NPI:1801166210
Name:DIAZ, YADHIRA A (DDS)
Entity type:Individual
Prefix:
First Name:YADHIRA
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12385
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-0385
Mailing Address - Country:US
Mailing Address - Phone:915-449-8589
Mailing Address - Fax:915-239-3374
Practice Address - Street 1:CARR. INTERNACIONAL WATERFILL #500
Practice Address - Street 2:
Practice Address - City:ZARAGOZA
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32550
Practice Address - Country:MX
Practice Address - Phone:915-820-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ2988099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist