Provider Demographics
NPI:1548021355
Name:YSQUIERDO, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:YSQUIERDO
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 1:710 BUFFALO ST STE 802
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-1902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:490 CRIPPLE CREEK CIR
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-9336
Practice Address - Country:US
Practice Address - Phone:507-363-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-304733106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician