MEDICARE: YULISSA DIAZ VILLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		CA

General Provider Information

NPI Number	:	1710842307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YULISSA DIAZ VILLA

Provider Business Mailing Address
First Line	:	PO BOX 2009
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95201-2009
Country	:	US
Telephone Number	:	209-468-3400
Fax Number	:	209-774-2570

Provider Business Practice Location Address
First Line	:	16980 S HARLAN RD
Second Line	:
City	:	LATHROP
State	:	CA
Zip	:	95330-8738
Country	:	US
Telephone Number	:	209-953-0223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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Directions to “ YULISSA DIAZ VILLA ” Practice Location

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