MEDICARE: YESID CARVAJAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	127797	TX

General Provider Information

NPI Number	:	1467023630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESID CARVAJAL

Provider Business Mailing Address
First Line	:	1222 WILLARD ST
Second Line	:	APARTMENT 2
City	:	HOUSTON
State	:	TX
Zip	:	77006-1141
Country	:	US
Telephone Number	:	281-235-6948
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 WILLARD ST
Second Line	:	APARTMENT 2
City	:	HOUSTON
State	:	TX
Zip	:	77006-1141
Country	:	US
Telephone Number	:	281-235-6948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	07/08/2021

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Directions to “ YESID CARVAJAL ” Practice Location

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