Provider Demographics
NPI:1689864514
Name:YEPEZ, SAMUEL JOSEPH JR (CCAPP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:YEPEZ
Suffix:JR
Gender:M
Credentials:CCAPP
Other - Prefix:
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Mailing Address - Street 1:1231N ELGIN STREET
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578
Mailing Address - Country:US
Mailing Address - Phone:510-586-1744
Mailing Address - Fax:510-535-2346
Practice Address - Street 1:3155 KEARNY STREET #150
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:844-682-7215
Practice Address - Fax:510-771-9910
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA60986101YA0400X
CAC041880118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)