Provider Demographics
NPI:1821838087
Name:VALLEJO, YVETTE PAOLA (PSM, RD)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:PAOLA
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:PSM, RD
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:PAOLA
Other - Last Name:NAVARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:332 N DOBSON RD UNIT 21
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6039
Mailing Address - Country:US
Mailing Address - Phone:915-702-8901
Mailing Address - Fax:
Practice Address - Street 1:332 N DOBSON RD UNIT 21
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6039
Practice Address - Country:US
Practice Address - Phone:915-702-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86360378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered