Provider Demographics
NPI:1265279657
Name:DIAZ, EVELYN YVETTE (LVN)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:YVETTE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12843 BERRYDALE ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-7923
Mailing Address - Country:US
Mailing Address - Phone:909-910-1404
Mailing Address - Fax:
Practice Address - Street 1:12240 HESPERIA RD STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8309
Practice Address - Country:US
Practice Address - Phone:760-245-8837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232183164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse