Provider Demographics
NPI:1679875157
Name:CESPEDES, YANINA
Entity Type:Individual
Prefix:
First Name:YANINA
Middle Name:
Last Name:CESPEDES
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 1:3940 SE POWELL AVE.
Mailing Address - Street 2:
Mailing Address - City:PORLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:503-772-4445
Mailing Address - Fax:
Practice Address - Street 1:3940 SE POWELL BOULEVARD
Practice Address - Street 2:
Practice Address - City:PORLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-772-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist