Provider Demographics
NPI:1962835140
Name:YEPEZ, RAUL ALBERTO
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:ALBERTO
Last Name:YEPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8204 BRYANT DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3135
Mailing Address - Country:US
Mailing Address - Phone:301-367-3659
Mailing Address - Fax:
Practice Address - Street 1:8421 AUBURN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0392
Practice Address - Country:US
Practice Address - Phone:916-531-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist