Provider Demographics
NPI:1679151070
Name:YZAGUIRRE, ANTHONY STEVEN
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:STEVEN
Last Name:YZAGUIRRE
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 1:12555 REDSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2165
Mailing Address - Country:US
Mailing Address - Phone:909-936-6884
Mailing Address - Fax:
Practice Address - Street 1:12555 REDSTONE CIR
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2165
Practice Address - Country:US
Practice Address - Phone:909-936-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57872355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty