Healthcare Provider Details

I. General information

NPI: 1407392103
Provider Name (Legal Business Name): MISS JULIE GISSELL YEPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 W FOOTHILL BLVD # 201
UPLAND CA
91786-3676
US

IV. Provider business mailing address

1317 W FOOTHILL BLVD # 201
UPLAND CA
91786-3676
US

V. Phone/Fax

Practice location:
  • Phone: 909-377-5060
  • Fax:
Mailing address:
  • Phone: 909-377-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: