Healthcare Provider Details

I. General information

NPI: 1700248200
Provider Name (Legal Business Name): IGNACIO YOGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

9842 13TH ST
GARDEN GROVE CA
92844-3171
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-P0GRBG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: