Healthcare Provider Details

I. General information

NPI: 1689112229
Provider Name (Legal Business Name): YAJAIRA JOCELYN URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 CHADBOURNE RD
FAIRFIELD CA
94534-9600
US

IV. Provider business mailing address

1141 PEAR TREE LN STE 100
NAPA CA
94558-6485
US

V. Phone/Fax

Practice location:
  • Phone: 707-419-8989
  • Fax: 707-254-1779
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: