Provider Demographics
NPI:1306169081
Name:DIAZ, YAHAIRA (MD)
Entity type:Individual
Prefix:
First Name:YAHAIRA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB LOS TAMARINDOS 6
Mailing Address - Street 2:#I-10
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-3727
Mailing Address - Country:US
Mailing Address - Phone:787-340-5103
Mailing Address - Fax:
Practice Address - Street 1:URB TAMARINDO 1
Practice Address - Street 2:I-10
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-3727
Practice Address - Country:US
Practice Address - Phone:787-340-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3539103TC1900X
PR15836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No104100000XBehavioral Health & Social Service ProvidersSocial Worker