Provider Demographics
NPI:1144979758
Name:BALTASAR, YESSENIA
Entity type:Individual
Prefix:
First Name:YESSENIA
Middle Name:
Last Name:BALTASAR
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 1:16117 S THORSON AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-4644
Mailing Address - Country:US
Mailing Address - Phone:562-508-6085
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:237 N CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3526
Practice Address - Country:US
Practice Address - Phone:661-360-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician