Healthcare Provider Details

I. General information

NPI: 1962283358
Provider Name (Legal Business Name): NICOLE A YLAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 ATLANTIC AVE
ALAMEDA CA
94501-1148
US

IV. Provider business mailing address

1005 ATLANTIC AVE
ALAMEDA CA
94501-1148
US

V. Phone/Fax

Practice location:
  • Phone: 510-695-3256
  • Fax:
Mailing address:
  • Phone: 510-695-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: