Provider Demographics
NPI:1851972350
Name:CASASOLA, YANIRA (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:YANIRA
Middle Name:
Last Name:CASASOLA
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5172 ARLINGTON AVE UNIT 4624
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92514-1026
Mailing Address - Country:US
Mailing Address - Phone:657-666-4455
Mailing Address - Fax:
Practice Address - Street 1:4571 E CARSON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1705
Practice Address - Country:US
Practice Address - Phone:657-666-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X
CA124Q00000X
CA813124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist