Provider Demographics
NPI:1598502007
Name:DIAZ MORALES, YOANDY (SA-C)
Entity type:Individual
Prefix:
First Name:YOANDY
Middle Name:
Last Name:DIAZ MORALES
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GREENS RD APT 607
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-2110
Mailing Address - Country:US
Mailing Address - Phone:832-529-5058
Mailing Address - Fax:
Practice Address - Street 1:400 GREENS RD APT 607
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2110
Practice Address - Country:US
Practice Address - Phone:832-529-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24-355246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant