Provider Demographics
NPI:1487168654
Name:PAZMINO, YESENIA DESIREE
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:DESIREE
Last Name:PAZMINO
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 1:301 AUDUBON AVENUE APT. 3F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033
Mailing Address - Country:US
Mailing Address - Phone:917-345-9665
Mailing Address - Fax:
Practice Address - Street 1:301 AUDUBON AVE APT 3F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4226
Practice Address - Country:US
Practice Address - Phone:917-345-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency