Provider Demographics
NPI:1942853890
Name:ARENAS, YVETTE
Entity Type:Individual
Prefix:MISS
First Name:YVETTE
Middle Name:
Last Name:ARENAS
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 1:2122 S EL CAMINO REAL STE 102
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6209
Mailing Address - Country:US
Mailing Address - Phone:760-290-8170
Mailing Address - Fax:760-439-0019
Practice Address - Street 1:2122 S EL CAMINO REAL STE 102
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6209
Practice Address - Country:US
Practice Address - Phone:760-290-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2021-10-20
Deactivation Date:2021-09-20
Deactivation Code:
Reactivation Date:2021-10-05
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
CARBT-19-92249106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator