Basic Information
| Provider Information | |||||||||
| NPI: | 1134485196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | YAMILE | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10286 NW 9TH STREET CIR APT 104 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331723220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7869917278 | ||||||||
| FaxNumber: | 3057574465 | ||||||||
| Practice Location | |||||||||
| Address1: | 3271 NW 7TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331254141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7869917278 | ||||||||
| FaxNumber: | 8667260526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2012 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 103K00000X | 1-21-53553 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.