Provider Demographics
NPI:1720890916
Name:DIAZ, YAJAIRA RAMONA (PA)
Entity type:Individual
Prefix:
First Name:YAJAIRA
Middle Name:RAMONA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 ELLA T GRASSO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1604
Mailing Address - Country:US
Mailing Address - Phone:754-209-6549
Mailing Address - Fax:
Practice Address - Street 1:1860 ELLA T GRASSO BLVD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1604
Practice Address - Country:US
Practice Address - Phone:754-209-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical