MEDICARE: YANIQUE DIAS NP, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP95033379	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	309712	AZ

General Provider Information

NPI Number	:	1710707534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANIQUE DIAS NP, PMHNP-BC

Provider Business Mailing Address
First Line	:	3835 N FREEWAY BLVD STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1954
Country	:	US
Telephone Number	:	916-576-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 N CENTRAL AVE FL 18
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-2322
Country	:	US
Telephone Number	:	646-941-7645
Fax Number	:	929-596-7897

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

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	02/03/2026

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