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General NPI Number Information
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NPI Number | 1407338858
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Entity Type | Individual
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Provider Name | LEENA YOUSEF-DIAZ APN
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Gender | Female
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Dates
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Enumeration Date | 09/02/2018
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Last Update Date | 09/02/2018
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Provider Practice Location Address
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Address Line | 1100 JOLIET STREET SUITE #201
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City | DYER
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State | IN
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Zip | 46311
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Country | US
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Telephone | 219-200-4676
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Fax |
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Provider Business Mailing Address
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Address Line | 5641 WEST 78TH STREET
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City | BURBANK
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State | IL
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Zip | 60459
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Country | US
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Telephone | 708-790-7771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209017754
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License Number State | IL
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