Provider Demographics
NPI:1104949510
Name:CALLEJAS, YEZID ALBERTO (NMD)
Entity type:Individual
Prefix:
First Name:YEZID
Middle Name:ALBERTO
Last Name:CALLEJAS
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 W DE PALMA CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-2606
Mailing Address - Country:US
Mailing Address - Phone:480-827-0121
Mailing Address - Fax:
Practice Address - Street 1:1620 W UNIVERSITY DR STE 11
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5359
Practice Address - Country:US
Practice Address - Phone:480-890-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04-799175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath