MEDICARE: LYSBETH PUENTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BEH-000518	AZ

General Provider Information

NPI Number	:	1922475573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYSBETH PUENTE

Provider Business Mailing Address
First Line	:	4366 W 12TH PL
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-8471
Country	:	US
Telephone Number	:	928-257-8883
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 W DUNLAP AVE STE 210
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5815
Country	:	US
Telephone Number	:	623-263-3966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	04/09/2026

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Directions to “ LYSBETH PUENTE ” Practice Location

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