Provider Demographics
NPI:1295864098
Name:YANEZ-GONZALES, TERESA ESPERANZA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ESPERANZA
Last Name:YANEZ-GONZALES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ESPERANZA
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2121 W TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4915
Mailing Address - Country:US
Mailing Address - Phone:323-333-7833
Mailing Address - Fax:
Practice Address - Street 1:2121 W TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4915
Practice Address - Country:US
Practice Address - Phone:323-333-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS2012163103TC0700X
CAPSY27320103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7420Medicaid
CA7420Medicaid