Healthcare Provider Details

I. General information

NPI: 1639654940
Provider Name (Legal Business Name): KEVIN CARREON YABES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HIGH BLUFF DR STE 220
SAN DIEGO CA
92130-2054
US

IV. Provider business mailing address

12625 HIGH BLUFF DR STE 220
SAN DIEGO CA
92130-2054
US

V. Phone/Fax

Practice location:
  • Phone: 808-336-7306
  • Fax:
Mailing address:
  • Phone: 808-336-7306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: