Healthcare Provider Details

I. General information

NPI: 1609661255
Provider Name (Legal Business Name): YAJAHIRA VACA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E 7TH ST
MADERA CA
93638-3780
US

IV. Provider business mailing address

901 SAUNDERS RD
MADERA CA
93637-6213
US

V. Phone/Fax

Practice location:
  • Phone: 559-395-0450
  • Fax: 559-662-5159
Mailing address:
  • Phone: 559-706-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: