Provider Demographics
NPI:1275901696
Name:PIETRI, YAXSAIRA
Entity Type:Individual
Prefix:
First Name:YAXSAIRA
Middle Name:
Last Name:PIETRI
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 1:539 POLK AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER ROUGE
Mailing Address - State:MI
Mailing Address - Zip Code:48218-1034
Mailing Address - Country:US
Mailing Address - Phone:313-957-8597
Mailing Address - Fax:
Practice Address - Street 1:539 POLK AVE
Practice Address - Street 2:
Practice Address - City:RIVER ROUGE
Practice Address - State:MI
Practice Address - Zip Code:48218-1034
Practice Address - Country:US
Practice Address - Phone:313-957-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other