Provider Demographics
NPI:1275801268
Name:ENCISO, MARIA YESENIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:YESENIA
Last Name:ENCISO
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 1:1000 CORPORATE CENTER DR STE 650
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7639
Mailing Address - Country:US
Mailing Address - Phone:323-526-4016
Mailing Address - Fax:323-526-4791
Practice Address - Street 1:6971 BANDINI BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-3329
Practice Address - Country:US
Practice Address - Phone:323-888-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner