Provider Demographics
NPI:1093725434
Name:CIHUACOATL, YESENIA (RD)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:CIHUACOATL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:YESENIA
Other - Middle Name:
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1617 N. CALIFORNIA STREET
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6019
Mailing Address - Country:US
Mailing Address - Phone:209-461-5268
Mailing Address - Fax:209-461-5395
Practice Address - Street 1:1617 N CALIFORNIA ST
Practice Address - Street 2:SUITE 2G
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:209-461-5268
Practice Address - Fax:209-461-5395
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA956706133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABW123YMedicare UPIN
CABW123XMedicare UPIN