Provider Demographics
NPI:1154613446
Name:VACA MACIAS, YOANA R (LVN)
Entity type:Individual
Prefix:
First Name:YOANA
Middle Name:R
Last Name:VACA MACIAS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 PACIFIC AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2272 PACIFIC AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4312
Practice Address - Country:US
Practice Address - Phone:562-427-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 247981164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN 247981OtherCALIFORNIA LICENSED VOCATIONAL NURSE