Provider Demographics
NPI:1831915719
Name:RUVALCABA-VENEGAS, YESENIA JANEL
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:JANEL
Last Name:RUVALCABA-VENEGAS
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 1:4444 E AVENUE R SPC 66
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-6709
Mailing Address - Country:US
Mailing Address - Phone:661-519-5142
Mailing Address - Fax:
Practice Address - Street 1:190 SIERRA CT STE B6
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7608
Practice Address - Country:US
Practice Address - Phone:323-426-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician