Basic Information
Provider Information
NPI: 1790754786
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YANEZ
FirstName: DARIA
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 22581
Address2:  
City: NEW YORK
State: NY
PostalCode: 100872581
CountryCode: US
TelephoneNumber: 6104824795
FaxNumber: 8565283117
Practice Location
Address1: 1088 W. BALTIMORE PK, HCC II, SUITE 2303
Address2:  
City: MEDIA
State: PA
PostalCode: 19063
CountryCode: US
TelephoneNumber: 6106274400
FaxNumber: 8882093560
Other Information
ProviderEnumerationDate: 03/14/2006
LastUpdateDate: 07/06/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/06/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XMD048599LPAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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