Provider Demographics
NPI:1629348529
Name:AGUIRRE-YANEZ, ALISA
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:AGUIRRE-YANEZ
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:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0087
Mailing Address - Country:US
Mailing Address - Phone:209-381-6879
Mailing Address - Fax:209-723-7432
Practice Address - Street 1:300 E 15TH ST STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6217
Practice Address - Country:US
Practice Address - Phone:209-381-6879
Practice Address - Fax:209-725-3775
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2020-10-30
Deactivation Date:2019-06-06
Deactivation Code:
Reactivation Date:2019-08-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health