Provider Demographics
NPI:1679145072
Name:RECENDEZ, AIRAM YASMEEN (PSYCHOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:AIRAM
Middle Name:YASMEEN
Last Name:RECENDEZ
Suffix:
Gender:F
Credentials:PSYCHOLOGY
Other - Prefix:
Other - First Name:AIRAM
Other - Middle Name:YASMEEN
Other - Last Name:RECENDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:
Practice Address - Street 1:501 W BROADWAY STE 800
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3546
Practice Address - Country:US
Practice Address - Phone:951-907-4895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2KXNKV4I103T00000X
2KXNKV4I103T00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103T00000XBehavioral Health & Social Service ProvidersPsychologist