Provider Demographics
NPI:1801206529
Name:BASTERRECHEA, YVONNE (CADC-II)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:
Last Name:BASTERRECHEA
Suffix:
Gender:F
Credentials:CADC-II
Other - Prefix:MISS
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:MENDIBLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC-II
Mailing Address - Street 1:4000 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3613
Mailing Address - Country:US
Mailing Address - Phone:951-955-4545
Mailing Address - Fax:
Practice Address - Street 1:4000 ORANGE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3613
Practice Address - Country:US
Practice Address - Phone:951-955-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054410519171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator