Provider Demographics
NPI:1003149956
Name:JARA, YVETTE ADRIANA RODRIGUEZ
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:ADRIANA RODRIGUEZ
Last Name:JARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 1/2 W COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-6204
Mailing Address - Country:US
Mailing Address - Phone:714-944-2190
Mailing Address - Fax:
Practice Address - Street 1:1755 HUNTINGTON DR
Practice Address - Street 2:103
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2567
Practice Address - Country:US
Practice Address - Phone:626-256-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW72302104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker