Provider Demographics
NPI:1518685908
Name:LARA, YESENIA (SLPA)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 W COMMONWEALTH AVE APT B2
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2987
Mailing Address - Country:US
Mailing Address - Phone:714-803-8848
Mailing Address - Fax:
Practice Address - Street 1:1480 S HARBOR BLVD STE 14
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7570
Practice Address - Country:US
Practice Address - Phone:562-284-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74202355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant