Provider Demographics
NPI:1306609250
Name:DIAZ RUIZ, YANEISI
Entity type:Individual
Prefix:
First Name:YANEISI
Middle Name:
Last Name:DIAZ RUIZ
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 1:1900 S TREASURE DR APT 9U
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4546
Mailing Address - Country:US
Mailing Address - Phone:305-465-1851
Mailing Address - Fax:
Practice Address - Street 1:1900 S TREASURE DR APT 9U
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4546
Practice Address - Country:US
Practice Address - Phone:305-465-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-322530106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician