Healthcare Provider Details

I. General information

NPI: 1376389361
Provider Name (Legal Business Name): YUSVIZARET DIMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 KITCHING ST
MORENO VALLEY CA
92553-6807
US

IV. Provider business mailing address

1569 W EVANS ST
SAN BERNARDINO CA
92411-1615
US

V. Phone/Fax

Practice location:
  • Phone: 951-571-4540
  • Fax:
Mailing address:
  • Phone: 909-522-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: