Provider Demographics
NPI:1972279032
Name:ARTOLA HERNANDEZ, YESSIKA ERENIA
Entity Type:Individual
Prefix:MRS
First Name:YESSIKA
Middle Name:ERENIA
Last Name:ARTOLA HERNANDEZ
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 1:2519 S OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2327
Mailing Address - Country:US
Mailing Address - Phone:202-718-3502
Mailing Address - Fax:
Practice Address - Street 1:2519 S OXFORD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2327
Practice Address - Country:US
Practice Address - Phone:202-718-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2509188021246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant