MEDICARE: DR. YANILIS DIAZ MD, PA

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	207Q00000X	Family Medicine Physician	002779-P.A.	FL

General Provider Information

NPI Number	:	1710825492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YANILIS DIAZ MD, PA

Provider Business Mailing Address
First Line	:	13300 SW 1ST ST APT O201
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33027-1611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13300 SW 1ST ST APT O201
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33027-1611
Country	:	US
Telephone Number	:	786-634-8945
Fax Number	:

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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