Basic Information
| Provider Information | |||||||||
| NPI: | 1982379574 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YANEZ | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 723 SAN PEDRO WAY | ||||||||
| Address2: | |||||||||
| City: | SOLEDAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939603557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313155670 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2199 H DELTA ROSA SR STREET | ||||||||
| Address2: | |||||||||
| City: | SOLEDAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8312234949 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2021 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.