Provider Demographics
NPI:1730547548
Name:YZAGUIRRE, KIMBERLY BRAUN (AMFT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BRAUN
Last Name:YZAGUIRRE
Suffix:
Gender:F
Credentials:AMFT
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Mailing Address - Street 1:16360 ROSCOE BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-1219
Mailing Address - Country:US
Mailing Address - Phone:818-908-4999
Mailing Address - Fax:818-376-0044
Practice Address - Street 1:16360 ROSCOE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1219
Practice Address - Country:US
Practice Address - Phone:818-980-4999
Practice Address - Fax:818-376-0044
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138695106H00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist