Provider Demographics
NPI:1225304330
Name:CROUSSETT, YARITZA ESTHELA (MOTR/L)
Entity Type:Individual
Prefix:MS
First Name:YARITZA
Middle Name:ESTHELA
Last Name:CROUSSETT
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 EMERALD LN APT K
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3325
Mailing Address - Country:US
Mailing Address - Phone:909-553-4455
Mailing Address - Fax:
Practice Address - Street 1:4020 EMERALD LN APT K
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3325
Practice Address - Country:US
Practice Address - Phone:909-553-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010000668171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor