MEDICARE: KEVIN YZAGUIRRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	143365	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	106H00000X	Marriage & Family Therapist	139894	CA

General Provider Information

NPI Number	:	1437540531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN YZAGUIRRE

Provider Business Mailing Address
First Line	:	14515 HAMLIN ST STE 100
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-1694
Country	:	US
Telephone Number	:	818-285-1900
Fax Number	:	818-285-1906

Provider Business Practice Location Address
First Line	:	14515 HAMLIN ST STE 100
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-1694
Country	:	US
Telephone Number	:	818-285-1900
Fax Number	:	818-285-1906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	11/13/2024

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