Provider Demographics
NPI:1720869449
Name:VALLEJO-CASSELYN, YESENIA MARISELA
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:MARISELA
Last Name:VALLEJO-CASSELYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YESENIA
Other - Middle Name:MARISELA
Other - Last Name:VALLEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39899 BALENTINE DR STE 128
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5361
Mailing Address - Country:US
Mailing Address - Phone:650-931-6300
Mailing Address - Fax:
Practice Address - Street 1:1710 S AMPHLETT BLVD STE 220
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2705
Practice Address - Country:US
Practice Address - Phone:650-762-4365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician