Healthcare Provider Details

I. General information

NPI: 1841335130
Provider Name (Legal Business Name): MS. LUCILLE ANDREA YGLESIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 N MAIN ST SUITE D-11
CORONA CA
92880-1407
US

IV. Provider business mailing address

1248 OHIO ST
REDLANDS CA
92374-3150
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-2962
  • Fax: 951-737-2783
Mailing address:
  • Phone: 909-798-9595
  • Fax: 951-737-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: