Provider Demographics
NPI:1467023630
Name:CARVAJAL, YESID
Entity Type:Individual
Prefix:
First Name:YESID
Middle Name:
Last Name:CARVAJAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 WILLARD ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1141
Mailing Address - Country:US
Mailing Address - Phone:281-235-6948
Mailing Address - Fax:
Practice Address - Street 1:1222 WILLARD ST
Practice Address - Street 2:APARTMENT 2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-1141
Practice Address - Country:US
Practice Address - Phone:281-235-6948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist