Basic Information
| Provider Information | |||||||||
| NPI: | 1780192625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YIP | ||||||||
| FirstName: | VANESA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2973 HARBOR BLVD # 136 | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926263912 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 17911 SKY PARK CIR STE E | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926144303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492020257 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2018 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 1-20-40930 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.