Provider Demographics
NPI:1376186072
Name:BADIGUE, YEGUE O (CMT)
Entity Type:Individual
Prefix:MR
First Name:YEGUE
Middle Name:O
Last Name:BADIGUE
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 E SPRUCE AVE APT 136
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0373
Mailing Address - Country:US
Mailing Address - Phone:559-205-5135
Mailing Address - Fax:
Practice Address - Street 1:2817 E SPRUCE AVE APT 136
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0373
Practice Address - Country:US
Practice Address - Phone:559-205-5135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81951225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist