Healthcare Provider Details

I. General information

NPI: 1912775867
Provider Name (Legal Business Name): TERRYLYNN MARIE YOUPELE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16552 SUNHILL DR
VICTORVILLE CA
92395-4518
US

IV. Provider business mailing address

11479 LA JOLLA CT
ADELANTO CA
92301-4242
US

V. Phone/Fax

Practice location:
  • Phone: 760-780-4400
  • Fax: 760-262-3976
Mailing address:
  • Phone: 909-331-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number16434045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: