Healthcare Provider Details

I. General information

NPI: 1659263911
Provider Name (Legal Business Name): YIRANDA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 PONCE DE LEON BLVD STE 100
CORAL GABLES FL
33146-2122
US

IV. Provider business mailing address

1065 SW 8TH ST # 1063
MIAMI FL
33130-3601
US

V. Phone/Fax

Practice location:
  • Phone: 786-708-7182
  • Fax:
Mailing address:
  • Phone: 786-708-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11040880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: