Provider Demographics
NPI:1750963096
Name:YANES, JESSICA (LICENSED MIDWIFE)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:YANES
Suffix:
Gender:F
Credentials:LICENSED MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10162 CUTTY SARK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4304
Mailing Address - Country:US
Mailing Address - Phone:512-956-1672
Mailing Address - Fax:
Practice Address - Street 1:10162 CUTTY SARK DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-4304
Practice Address - Country:US
Practice Address - Phone:512-956-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99436176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX99436OtherMIDWIFERY LICENSE NUMBER