Healthcare Provider Details

I. General information

NPI: 1558986554
Provider Name (Legal Business Name): YULISSA ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36101 BOB HOPE DR STE A
RANCHO MIRAGE CA
92270-2001
US

IV. Provider business mailing address

84032 LAGUNA LN
COACHELLA CA
92236-9592
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-1315
  • Fax: 760-321-1094
Mailing address:
  • Phone: 760-296-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: