Healthcare Provider Details

I. General information

NPI: 1306496351
Provider Name (Legal Business Name): ADRIANA YEPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ALAMEDA DE LAS PULGAS
SAN MATEO CA
94403-1269
US

IV. Provider business mailing address

5109 BOGART DR
CERES CA
95307-9767
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number96593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: