MEDICARE: YEZICA FISHER R511

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	101YS0200X	School Counselor	220058170	CA

General Provider Information

NPI Number	:	1821949132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEZICA FISHER R511

Provider Business Mailing Address
First Line	:	43141 BUSINESS CENTER PKWY STE 101
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-4532
Country	:	US
Telephone Number	:	951-401-7496
Fax Number	:

Provider Business Practice Location Address
First Line	:	43141 BUSINESS CENTER PKWY STE 101
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-4532
Country	:	US
Telephone Number	:	951-401-7496
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/13/2026

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