Healthcare Provider Details

I. General information

NPI: 1710707534
Provider Name (Legal Business Name): YANIQUE DIAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N CENTRAL AVE FL 18
PHOENIX AZ
85004-2322
US

IV. Provider business mailing address

36800 OAK MEADOWS PL
MURRIETA CA
92562-4386
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 951-525-2734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95033379
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number309712
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: