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General NPI Number Information
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NPI Number | 1023990942
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Entity Type | Individual
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Provider Name | MAXINE ABELLANOSA
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Gender | Female
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 35320 DAGGETT YERMO RD
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City | YERMO
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State | CA
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Zip | 92398-0408
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Country | US
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Telephone | 760-514-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 20821 US HIGHWAY 18
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City | APPLE VALLEY
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State | CA
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Zip | 92307-3549
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Country | US
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Telephone | 909-215-8065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 210050499
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License Number State | CA
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