Provider Demographics
NPI:1093062747
Name:MALDONADO AVILES, YAZMIN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:YAZMIN
Middle Name:
Last Name:MALDONADO AVILES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:YAZMIN
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 SANTA ANA N
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-2106
Mailing Address - Country:US
Mailing Address - Phone:424-395-7835
Mailing Address - Fax:
Practice Address - Street 1:2450 SANTA ANA N
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2106
Practice Address - Country:US
Practice Address - Phone:424-395-7835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA124203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator