Healthcare Provider Details

I. General information

NPI: 1801206529
Provider Name (Legal Business Name): YVONNE BASTERRECHEA CADC-II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YVONNE MENDIBLES CADC-II

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ORANGE ST
RIVERSIDE CA
92501-3613
US

IV. Provider business mailing address

4000 ORANGE ST
RIVERSIDE CA
92501-3613
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-4545
  • Fax:
Mailing address:
  • Phone: 951-955-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberA054410519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: