Provider Demographics
NPI:1598201170
Name:ACEVEDO, ESTELA YASMIN (BA, RBT)
Entity Type:Individual
Prefix:MRS
First Name:ESTELA
Middle Name:YASMIN
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:MS
Other - First Name:ESTELA
Other - Middle Name:YASMIN
Other - Last Name:ACEVEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:239 E 47TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-1209
Mailing Address - Country:US
Mailing Address - Phone:909-379-4527
Mailing Address - Fax:
Practice Address - Street 1:239 E 47TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-1209
Practice Address - Country:US
Practice Address - Phone:909-379-4527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician