Provider Demographics
NPI:1417439902
Name:DIAZ VAZQUEZ, YAIMARA
Entity type:Individual
Prefix:
First Name:YAIMARA
Middle Name:
Last Name:DIAZ VAZQUEZ
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 1:116 LAUGHLIN DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-6015
Mailing Address - Country:US
Mailing Address - Phone:770-286-5114
Mailing Address - Fax:888-493-4555
Practice Address - Street 1:116 LAUGHLIN DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-6015
Practice Address - Country:US
Practice Address - Phone:770-286-5114
Practice Address - Fax:888-493-4555
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator