Provider Demographics
NPI:1548908494
Name:NISPEROS, YANICA NERA
Entity type:Individual
Prefix:MISS
First Name:YANICA
Middle Name:NERA
Last Name:NISPEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:YANI
Other - Middle Name:NERA
Other - Last Name:NISPEROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:62 GOLDEN GLEN ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2454
Mailing Address - Country:US
Mailing Address - Phone:949-877-2767
Mailing Address - Fax:
Practice Address - Street 1:62 GOLDEN GLEN ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-2454
Practice Address - Country:US
Practice Address - Phone:949-877-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician