Healthcare Provider Details

I. General information

NPI: 1588341978
Provider Name (Legal Business Name): YVONNE OWUOR PMHNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 RED GOLD ST
EASTVALE CA
92880-3125
US

IV. Provider business mailing address

5959 RED GOLD ST
EASTVALE CA
92880-3125
US

V. Phone/Fax

Practice location:
  • Phone: 909-287-4286
  • Fax:
Mailing address:
  • Phone: 909-287-4286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030552
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030552
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95022150
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number95022150
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95022150
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95022150
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number95022150
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95022150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: