Healthcare Provider Details

I. General information

NPI: 1073276416
Provider Name (Legal Business Name): DANIELA YEPEZ YEPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12437 LEWIS ST STE 100
GARDEN GROVE CA
92840-4651
US

IV. Provider business mailing address

4930 ADAMS AVE
SALIDA CA
95368-9458
US

V. Phone/Fax

Practice location:
  • Phone: 714-750-7566
  • Fax:
Mailing address:
  • Phone: 209-895-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: