Provider Demographics
NPI:1972095164
Name:DECAPUA, YESENIA (DIPL AC, LAC)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:DECAPUA
Suffix:
Gender:F
Credentials:DIPL AC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 WESTMAR CT UNIT 1
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2074
Mailing Address - Country:US
Mailing Address - Phone:419-215-8799
Mailing Address - Fax:
Practice Address - Street 1:120 W DUDLEY ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2141
Practice Address - Country:US
Practice Address - Phone:419-345-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000347171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist