Individual
KIANNA YADIRA VASAVILBASO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
435 N 5TH ST, PHOENIX, AZ 85004-2157
(602) 827-2834
Mailing address
397 VIA ALOE VERA, RIO RICO, AZ 85648-2961
(520) 313-5674
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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