Provider Demographics
NPI:1003359373
Name:HINOJOSA, YVONNE (MT)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:HINOJOSA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 SUSSEX LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1533
Mailing Address - Country:US
Mailing Address - Phone:512-297-3015
Mailing Address - Fax:
Practice Address - Street 1:6140 TUTT BLVD
Practice Address - Street 2:# 120
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3575
Practice Address - Country:US
Practice Address - Phone:719-266-0438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023593OtherMT
CO0018974OtherMT