Healthcare Provider Details

I. General information

NPI: 1558175273
Provider Name (Legal Business Name): YAZA VEGA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 N HOLLYWOOD WAY
BURBANK CA
91505-1055
US

IV. Provider business mailing address

2550 N HOLLYWOOD WAY
BURBANK CA
91505-1055
US

V. Phone/Fax

Practice location:
  • Phone: 747-283-1809
  • Fax: 323-306-0716
Mailing address:
  • Phone: 747-283-1809
  • Fax: 323-306-0716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95030720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: