Healthcare Provider Details

I. General information

NPI: 1790336634
Provider Name (Legal Business Name): YANETH PUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W FOOTHILL BLVD UNIT A SAN DIMAS
SAN DIMAS CA
91773-1103
US

IV. Provider business mailing address

150 W FOOTHILL BLVD UNIT A SAN DIMAS
SAN DIMAS CA
91773-1103
US

V. Phone/Fax

Practice location:
  • Phone: 626-507-3585
  • Fax: 626-884-1196
Mailing address:
  • Phone: 626-507-3585
  • Fax: 626-884-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: