Provider Demographics
NPI:1063271849
Name:DIAZ CHINEA, YEISY
Entity type:Individual
Prefix:
First Name:YEISY
Middle Name:
Last Name:DIAZ CHINEA
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 1:1196 NW 79TH ST APT 8205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-3301
Mailing Address - Country:US
Mailing Address - Phone:305-901-9531
Mailing Address - Fax:
Practice Address - Street 1:1196 NW 79TH ST APT 8205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-3301
Practice Address - Country:US
Practice Address - Phone:305-901-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-321722106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty