Provider Demographics
NPI:1053136200
Name:YEH, FONDA (APCC)
Entity type:Individual
Prefix:MRS
First Name:FONDA
Middle Name:
Last Name:YEH
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 BROADWAY UNIT 2323
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5735
Mailing Address - Country:US
Mailing Address - Phone:321-230-0998
Mailing Address - Fax:
Practice Address - Street 1:1480 BROADWAY UNIT 2323
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5735
Practice Address - Country:US
Practice Address - Phone:321-230-0998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health