Provider Demographics
NPI:1588280788
Name:VIEYRA AVILES, YENNY M
Entity type:Individual
Prefix:
First Name:YENNY
Middle Name:M
Last Name:VIEYRA AVILES
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 1:3879 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3821
Mailing Address - Country:US
Mailing Address - Phone:951-289-8306
Mailing Address - Fax:
Practice Address - Street 1:3879 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3821
Practice Address - Country:US
Practice Address - Phone:951-289-8306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336426546310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility