Provider Demographics
NPI:1598441198
Name:CHAVARRIA BANEGAS, YENY YAMILET
Entity Type:Individual
Prefix:
First Name:YENY
Middle Name:YAMILET
Last Name:CHAVARRIA BANEGAS
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 1:2107 YOSEMITE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2701
Mailing Address - Country:US
Mailing Address - Phone:818-471-5591
Mailing Address - Fax:
Practice Address - Street 1:2107 YOSEMITE DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-2701
Practice Address - Country:US
Practice Address - Phone:818-471-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36614R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine