Provider Demographics
NPI:1811667736
Name:ASCENCIO, NAYELLI LISBETH
Entity type:Individual
Prefix:
First Name:NAYELLI
Middle Name:LISBETH
Last Name:ASCENCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3915
Mailing Address - Country:US
Mailing Address - Phone:951-258-9462
Mailing Address - Fax:
Practice Address - Street 1:233 S QUINTANA DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4029
Practice Address - Country:US
Practice Address - Phone:714-202-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health