Provider Demographics
NPI:1437651890
Name:YANEZ, CHRISTINA MONIQUE (RBT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MONIQUE
Last Name:YANEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MONIQUE
Other - Last Name:YANEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:1631 GLORIA DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-2694
Mailing Address - Country:US
Mailing Address - Phone:209-561-0676
Mailing Address - Fax:
Practice Address - Street 1:18051 N RAY RD
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-9309
Practice Address - Country:US
Practice Address - Phone:916-420-3165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106SOOOOOX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106SOOOOOXMedicaid