Provider Demographics
NPI:1841185816
Name:DIAZ DE JESUS, YARITZA
Entity type:Individual
Prefix:
First Name:YARITZA
Middle Name:
Last Name:DIAZ DE JESUS
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 1:79 CALLE CEIBA
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-2543
Mailing Address - Country:US
Mailing Address - Phone:787-380-4624
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 579
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792-0579
Practice Address - Country:US
Practice Address - Phone:787-852-7739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist