Provider Demographics
NPI:1689488173
Name:CONTRERAS, MAYRA YESENIA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:YESENIA
Last Name:CONTRERAS
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 1:12440 FIRESTONE BLVD STE 3001
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4300
Mailing Address - Country:US
Mailing Address - Phone:562-450-0620
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD STE 3001
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4300
Practice Address - Country:US
Practice Address - Phone:562-450-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-09-11
Deactivation Date:2025-02-04
Deactivation Code:
Reactivation Date:2025-09-11
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker