Individual
MARCUS DEWAYNE YANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
644 E JEFFERSON AVE, BASTROP, LA 71220-4619
(318) 239-3862
Mailing address
644 E JEFFERSON AVE, BASTROP, LA 71220-4619
(318) 239-3862
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558770867
—
LA
Enumeration date
05/18/2017
Last updated
07/21/2022
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