Provider Demographics
NPI:1255921748
Name:MACHADO-ROSSELLE, YESSENIA YASMIN
Entity type:Individual
Prefix:
First Name:YESSENIA
Middle Name:YASMIN
Last Name:MACHADO-ROSSELLE
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 1:9890 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3404
Mailing Address - Country:US
Mailing Address - Phone:619-992-4164
Mailing Address - Fax:
Practice Address - Street 1:9890 AUSTIN DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-3404
Practice Address - Country:US
Practice Address - Phone:619-992-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021699163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care