Healthcare Provider Details

I. General information

NPI: 1184290686
Provider Name (Legal Business Name): YULIANA BAEZ VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 09/15/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST
MODESTO CA
95350-5814
US

IV. Provider business mailing address

1620 COLORADO AVE
TURLOCK CA
95382-2713
US

V. Phone/Fax

Practice location:
  • Phone: 209-552-2720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: