Provider Demographics
NPI:1346830726
Name:OSTOLAZA-MACHUCA, YESENIA (DC)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:OSTOLAZA-MACHUCA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 RENAISSANCE POINTE APT 102
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3511
Mailing Address - Country:US
Mailing Address - Phone:470-314-6991
Mailing Address - Fax:
Practice Address - Street 1:955 W STATE ROAD 436 STE 1010
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2917
Practice Address - Country:US
Practice Address - Phone:470-314-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor