Provider Demographics
NPI:1043907819
Name:CARBAJAL, IRMA YESSENIA
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:YESSENIA
Last Name:CARBAJAL
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 1:650 N IMPERIAL AVE UNIT 12
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-1642
Mailing Address - Country:US
Mailing Address - Phone:760-879-2094
Mailing Address - Fax:
Practice Address - Street 1:650 N IMPERIAL AVE UNIT 12
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-1642
Practice Address - Country:US
Practice Address - Phone:760-879-2094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst