Healthcare Provider Details

I. General information

NPI: 1831915719
Provider Name (Legal Business Name): YESENIA JANEL RUVALCABA-VENEGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 SIERRA CT STE B6
PALMDALE CA
93550-7608
US

IV. Provider business mailing address

4444 E AVENUE R SPC 66
PALMDALE CA
93552-6709
US

V. Phone/Fax

Practice location:
  • Phone: 323-426-6402
  • Fax:
Mailing address:
  • Phone: 661-519-5142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: