Provider Demographics
NPI:1588157648
Name:PEREZ :LOPEZ, YOSELIN YOSAGANDI
Entity type:Individual
Prefix:
First Name:YOSELIN
Middle Name:YOSAGANDI
Last Name:PEREZ :LOPEZ
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 1:2002 W DALI WAY
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-9787
Mailing Address - Country:US
Mailing Address - Phone:559-904-9767
Mailing Address - Fax:
Practice Address - Street 1:2002 W DALI WAY
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-9787
Practice Address - Country:US
Practice Address - Phone:559-904-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA109645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist