Provider Demographics
NPI:1992731103
Name:HEREDIA-KOSTER, YVONNE (ATC)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:
Last Name:HEREDIA-KOSTER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:HEREDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:6724 DESERT CANYON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7604
Mailing Address - Country:US
Mailing Address - Phone:915-845-3152
Mailing Address - Fax:
Practice Address - Street 1:2900 PERSHING DR
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2403
Practice Address - Country:US
Practice Address - Phone:915-562-8525
Practice Address - Fax:915-566-3889
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer