Provider Demographics
NPI:1487301313
Name:DIAZ YANES, LISET
Entity type:Individual
Prefix:
First Name:LISET
Middle Name:
Last Name:DIAZ YANES
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 1:17424 NW 63RD CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4485
Mailing Address - Country:US
Mailing Address - Phone:786-587-3684
Mailing Address - Fax:
Practice Address - Street 1:1041 CATALONIA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6302
Practice Address - Country:US
Practice Address - Phone:305-290-0622
Practice Address - Fax:866-802-2363
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22885225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist