Basic Information
| Provider Information | |||||||||
| NPI: | 1437540531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YZAGUIRRE | ||||||||
| FirstName: | KEVIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14515 HAMLIN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914111694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182851900 | ||||||||
| FaxNumber: | 8182851906 | ||||||||
| Practice Location | |||||||||
| Address1: | 14515 HAMLIN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914111694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182851900 | ||||||||
| FaxNumber: | 8182851906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2015 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 143365 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.