Provider Demographics
NPI:1487380978
Name:AGUILAR, YVETTE CASSANDRA (MA61310281)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:CASSANDRA
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:MA61310281
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 RIVERSIDE DR APTA201
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801
Mailing Address - Country:US
Mailing Address - Phone:210-296-1358
Mailing Address - Fax:
Practice Address - Street 1:151 S WORTHEN ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3025
Practice Address - Country:US
Practice Address - Phone:509-888-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61310281225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist