Provider Demographics
NPI:1407575038
Name:OCEGUERA-ROCHA, YAJAIRA
Entity Type:Individual
Prefix:
First Name:YAJAIRA
Middle Name:
Last Name:OCEGUERA-ROCHA
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 1:47872 MORONGO RD
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-6943
Mailing Address - Country:US
Mailing Address - Phone:951-392-5107
Mailing Address - Fax:
Practice Address - Street 1:940 E WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5848
Practice Address - Country:US
Practice Address - Phone:951-588-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
CAAPCC14469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist