Healthcare Provider Details

I. General information

NPI: 1891276234
Provider Name (Legal Business Name): MISS YESENIA CHAVEZGONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD STE 203
HAWAIIAN GARDENS CA
90716-2601
US

IV. Provider business mailing address

21520 PIONEER BLVD STE 203
HAWAIIAN GARDENS CA
90716-2601
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax:
Mailing address:
  • Phone: 562-865-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: