Provider Demographics
NPI:1992680144
Name:COOSEMANS NOVALES, YESSICA MARIA (DDS)
Entity type:Individual
Prefix:
First Name:YESSICA
Middle Name:MARIA
Last Name:COOSEMANS NOVALES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:YESSICA
Other - Middle Name:MARIA
Other - Last Name:COOSEMANS RUEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19721 ALYSSA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2144
Mailing Address - Country:US
Mailing Address - Phone:661-644-9238
Mailing Address - Fax:
Practice Address - Street 1:1423 E GAGE AVE STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1771
Practice Address - Country:US
Practice Address - Phone:323-983-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112206122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist