Provider Demographics
NPI:1518121789
Name:DICOCHEA, YESENIA
Entity Type:Individual
Prefix:MRS
First Name:YESENIA
Middle Name:
Last Name:DICOCHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YESENIA
Other - Middle Name:
Other - Last Name:AGUILAR DELGADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:424 E PRESIDENT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714
Mailing Address - Country:US
Mailing Address - Phone:520-806-8025
Mailing Address - Fax:520-806-8035
Practice Address - Street 1:424 E PRESIDENT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714
Practice Address - Country:US
Practice Address - Phone:520-806-8025
Practice Address - Fax:520-806-8035
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-6231310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ117961OtherAHCCCS PROVIDER NUMBER