Provider Demographics
NPI:1154012714
Name:MACEDO, YOHANNA
Entity type:Individual
Prefix:
First Name:YOHANNA
Middle Name:
Last Name:MACEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 RICKENBACKER RD
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-6418
Mailing Address - Country:US
Mailing Address - Phone:323-263-1206
Mailing Address - Fax:
Practice Address - Street 1:5600 RICKENBACKER RD
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-6418
Practice Address - Country:US
Practice Address - Phone:323-263-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1507340523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)