Provider Demographics
NPI:1043337793
Name:ENTRENAS-YEPEZ, VILMA G (PHD)
Entity type:Individual
Prefix:
First Name:VILMA
Middle Name:G
Last Name:ENTRENAS-YEPEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2603
Mailing Address - Country:US
Mailing Address - Phone:415-337-4800
Mailing Address - Fax:415-333-2058
Practice Address - Street 1:4527 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2603
Practice Address - Country:US
Practice Address - Phone:415-337-4800
Practice Address - Fax:415-333-2058
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19765103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
17704OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
17704OtherSFGH INTERNAL USE ONLY