Provider Demographics
NPI:1467324319
Name:HERNANDEZ-DIAZ, YVETTE (PPS)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:HERNANDEZ-DIAZ
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14030 MCCLURE AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-2274
Mailing Address - Country:US
Mailing Address - Phone:562-340-3372
Mailing Address - Fax:
Practice Address - Street 1:16315 GREVILLEA AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2858
Practice Address - Country:US
Practice Address - Phone:310-214-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-20
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2502075731041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool