Healthcare Provider Details

I. General information

NPI: 1275451304
Provider Name (Legal Business Name): AMANDA YEBRA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 LIMAN WAY
ROHNERT PARK CA
94928-4686
US

IV. Provider business mailing address

8201 CAMINO COLEGIO APT 189
ROHNERT PARK CA
94928-8148
US

V. Phone/Fax

Practice location:
  • Phone: 707-792-4840
  • Fax:
Mailing address:
  • Phone:
  • 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: