Healthcare Provider Details

I. General information

NPI: 1932037694
Provider Name (Legal Business Name): DOMINIQUE YEPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 H ST STE 25A
BAKERSFIELD CA
93301-5134
US

IV. Provider business mailing address

1326 H ST STE 25A
BAKERSFIELD CA
93301-5134
US

V. Phone/Fax

Practice location:
  • Phone: 661-310-3688
  • Fax:
Mailing address:
  • Phone: 661-310-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: