Provider Demographics
NPI:1821704438
Name:VENEGAS, YAJAIRA (CPSW)
Entity Type:Individual
Prefix:
First Name:YAJAIRA
Middle Name:
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CORTEZ AVE
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NM
Mailing Address - Zip Code:88043-9744
Mailing Address - Country:US
Mailing Address - Phone:575-956-6131
Mailing Address - Fax:
Practice Address - Street 1:610 N SILVER ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6779
Practice Address - Country:US
Practice Address - Phone:575-956-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1519175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist