Healthcare Provider Details

I. General information

NPI: 1801381132
Provider Name (Legal Business Name): VALENCIA YOUKHANNA B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 12/16/2025
Certification Date: 07/07/2020
Deactivation Date: 07/07/2020
Reactivation Date: 12/16/2025

III. Provider practice location address

2499 E LAKESHORE DR
LAKE ELSINORE CA
92530-4411
US

IV. Provider business mailing address

1525 CEDARHILL DR
RIVERSIDE CA
92507-5973
US

V. Phone/Fax

Practice location:
  • Phone: 951-471-4200
  • Fax:
Mailing address:
  • Phone: 619-672-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: