Healthcare Provider Details

I. General information

NPI: 1588382170
Provider Name (Legal Business Name): YESSENIA ELIZABETH NEVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 PLUMMER ST
CHATSWORTH CA
91311-4903
US

IV. Provider business mailing address

21000 PLUMMER ST
CHATSWORTH CA
91311-4903
US

V. Phone/Fax

Practice location:
  • Phone: 818-882-6400
  • Fax: 818-882-6404
Mailing address:
  • Phone: 818-882-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1529771023
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131219
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: