Basic Information
| Provider Information | |||||||||
| NPI: | 1326439217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YESCAS | ||||||||
| FirstName: | MIGUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 SMILAX RD | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920695910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608930345 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 RANCHEROS DR | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920692900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607443672 | ||||||||
| FaxNumber: | 7607446182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2015 | ||||||||
| LastUpdateDate: | 02/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R82531214 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.