Provider Demographics
NPI:1306541271
Name:CAYCEDO, YVONNE ALEXANDRA
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:ALEXANDRA
Last Name:CAYCEDO
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 1:20929 VENTURA BLVD STE 47-302
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2334
Mailing Address - Country:US
Mailing Address - Phone:323-219-1555
Mailing Address - Fax:
Practice Address - Street 1:1624 CAMINO ROCIAR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-7226
Practice Address - Country:US
Practice Address - Phone:323-219-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-305694174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN