Provider Demographics
NPI:1598952228
Name:YANEZ, JOSE (MA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:YANEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2285
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004
Mailing Address - Country:US
Mailing Address - Phone:505-882-5101
Mailing Address - Fax:505-882-6127
Practice Address - Street 1:820 HWY 478
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021
Practice Address - Country:US
Practice Address - Phone:505-882-5101
Practice Address - Fax:505-882-6127
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist