Provider Demographics
NPI:1023115649
Name:YANEZ, GLADYS GLORIA (MH)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:GLORIA
Last Name:YANEZ
Suffix:
Gender:F
Credentials:MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S A ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3685
Mailing Address - Country:US
Mailing Address - Phone:714-573-1567
Mailing Address - Fax:
Practice Address - Street 1:130 S A ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3685
Practice Address - Country:US
Practice Address - Phone:714-573-1567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY0503161919101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)