Healthcare Provider Details

I. General information

NPI: 1124630710
Provider Name (Legal Business Name): YENI BATRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E CARSON ST STE J
CARSON CA
90745-7712
US

IV. Provider business mailing address

441 E CARSON ST STE J
CARSON CA
90745-7712
US

V. Phone/Fax

Practice location:
  • Phone: 424-392-4984
  • Fax:
Mailing address:
  • Phone: 424-392-4984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number83042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: