Provider Demographics
NPI:1174116768
Name:DIAZ, YOLANDA L
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:L
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:L
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TRABAJADOR SOCIAL
Mailing Address - Street 1:CARR 819
Mailing Address - Street 2:PARCELA 488 VILLA DEL RIO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-904-8071
Mailing Address - Fax:
Practice Address - Street 1:1100 MARGINAL RUIZ SOLER
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7365
Practice Address - Country:US
Practice Address - Phone:787-904-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7851104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7851OtherLICENCIA DE TRABAJO SOCIAL