Healthcare Provider Details

I. General information

NPI: 1508127879
Provider Name (Legal Business Name): YESENIA TALAVERA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 REYNOLDS RD
RIVERSIDE CA
92503-3517
US

IV. Provider business mailing address

511 N BROOKHURST ST STE 200
ANAHEIM CA
92801-5229
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4466
  • Fax: 951-543-4359
Mailing address:
  • Phone: 714-780-0750
  • Fax: 714-780-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: