Healthcare Provider Details

I. General information

NPI: 1295337780
Provider Name (Legal Business Name): WILLIAM A YANEZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 BRISTOL ST STE 130
COSTA MESA CA
92626-5985
US

IV. Provider business mailing address

2755 BRISTOL ST STE 130
COSTA MESA CA
92626-5985
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-2950
  • Fax: 714-557-2487
Mailing address:
  • Phone: 714-966-2950
  • Fax: 714-557-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number50485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: