Provider Demographics
NPI:1528454808
Name:YANEZ, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:YANEZ
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 1:4400 SAN CARLOS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5369
Mailing Address - Country:US
Mailing Address - Phone:703-250-0242
Mailing Address - Fax:
Practice Address - Street 1:4400 SAN CARLOS DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5369
Practice Address - Country:US
Practice Address - Phone:703-250-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401171920376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide