Provider Demographics
NPI:1144823626
Name:DIAZ-VAZQUEZ, YVONNE THERESA
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:THERESA
Last Name:DIAZ-VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6728 RAVEN CRST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9235
Mailing Address - Country:US
Mailing Address - Phone:937-684-2964
Mailing Address - Fax:
Practice Address - Street 1:6728 RAVEN CRST
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-9235
Practice Address - Country:US
Practice Address - Phone:937-684-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker