Provider Demographics
NPI:1053928614
Name:MARTINEZ, YESENIA ISELA
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:ISELA
Last Name:MARTINEZ
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 1:1205 E HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3318
Mailing Address - Country:US
Mailing Address - Phone:956-728-0440
Mailing Address - Fax:956-722-7589
Practice Address - Street 1:1205 E HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3318
Practice Address - Country:US
Practice Address - Phone:956-728-0440
Practice Address - Fax:956-722-7589
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9811101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)