Healthcare Provider Details

I. General information

NPI: 1265223671
Provider Name (Legal Business Name): MRS. YAJAIRA VANESSA DIAZ SR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SATELLITE POINTE APT 7207
DULUTH GA
30096-5734
US

IV. Provider business mailing address

2000 SATELLITE POINTE APT 7207
DULUTH GA
30096-5734
US

V. Phone/Fax

Practice location:
  • Phone: 786-262-7955
  • Fax:
Mailing address:
  • Phone: 786-262-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number23653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: