Provider Demographics
NPI:1437486651
Name:YGLESIAS, PATRICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:YGLESIAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17662 IRVINE BLVD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3149
Mailing Address - Country:US
Mailing Address - Phone:714-558-0971
Mailing Address - Fax:714-544-5428
Practice Address - Street 1:17662 IRVINE BLVD
Practice Address - Street 2:SUITE 21
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3149
Practice Address - Country:US
Practice Address - Phone:714-558-0971
Practice Address - Fax:714-544-5428
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8964103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist