Provider Demographics
NPI:1407370604
Name:YEE, VANESSA JOY (CMT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:JOY
Last Name:YEE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:JOY
Other - Last Name:BLEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 MAGNOLIA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3123
Mailing Address - Country:US
Mailing Address - Phone:951-905-0454
Mailing Address - Fax:
Practice Address - Street 1:800 MAGNOLIA AVE STE 105
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3123
Practice Address - Country:US
Practice Address - Phone:951-905-0454
Practice Address - Fax:951-905-0454
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2017-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72796225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist