Provider Demographics
NPI:1700611944
Name:CUAUTLE CUAUTLE, YESENIA
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:CUAUTLE CUAUTLE
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 1:633 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6010
Mailing Address - Country:US
Mailing Address - Phone:909-640-1808
Mailing Address - Fax:
Practice Address - Street 1:633 E 2ND ST
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6010
Practice Address - Country:US
Practice Address - Phone:909-640-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician