Provider Demographics
NPI:1063020550
Name:RAYGOZA, YESENIA
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:RAYGOZA
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 1:956 WILLOW BND
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-2705
Mailing Address - Country:US
Mailing Address - Phone:210-701-6165
Mailing Address - Fax:
Practice Address - Street 1:2040 BABCOCK RD STE 304
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4428
Practice Address - Country:US
Practice Address - Phone:210-731-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336356164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse