Healthcare Provider Details

I. General information

NPI: 1508336108
Provider Name (Legal Business Name): MS. YESSENIA CARAPIA GAMBOA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 2ND ST
BRENTWOOD CA
94513-1132
US

IV. Provider business mailing address

850 2ND ST
BRENTWOOD CA
94513-1132
US

V. Phone/Fax

Practice location:
  • Phone: 925-634-3521
  • Fax:
Mailing address:
  • Phone: 925-634-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220122163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: