Healthcare Provider Details

I. General information

NPI: 1659199164
Provider Name (Legal Business Name): IZZA MARIE YEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22030 SHERMAN WAY STE 211
CANOGA PARK CA
91303-1882
US

IV. Provider business mailing address

24006 FRIAR ST
WOODLAND HILLS CA
91367-1238
US

V. Phone/Fax

Practice location:
  • Phone: 559-231-5366
  • Fax:
Mailing address:
  • Phone: 818-917-6768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: