Healthcare Provider Details

I. General information

NPI: 1831932631
Provider Name (Legal Business Name): MARIA YEPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 S STATE ST STE 107
UKIAH CA
95482-5858
US

IV. Provider business mailing address

776 S STATE ST STE 107
UKIAH CA
95482-5858
US

V. Phone/Fax

Practice location:
  • Phone: 707-510-7762
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: