Healthcare Provider Details

I. General information

NPI: 1922475573
Provider Name (Legal Business Name): LYSBETH PUENTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 W DUNLAP AVE STE 210
PHOENIX AZ
85021-5815
US

IV. Provider business mailing address

4366 W 12TH PL
YUMA AZ
85364-8471
US

V. Phone/Fax

Practice location:
  • Phone: 623-263-3966
  • Fax:
Mailing address:
  • Phone: 928-257-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000518
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: