Healthcare Provider Details

I. General information

NPI: 1588494348
Provider Name (Legal Business Name): YARELI YESENDI BARRAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 7TH ST E
SAINT PAUL MN
55106-5070
US

IV. Provider business mailing address

797 7TH ST E
SAINT PAUL MN
55106-5070
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-4200
  • Fax:
Mailing address:
  • Phone: 651-379-4200
  • Fax: 612-887-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number10185
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: