Healthcare Provider Details

I. General information

NPI: 1679656474
Provider Name (Legal Business Name): JEAN E YANO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W BADILLO ST STE E
COVINA CA
91723-1923
US

IV. Provider business mailing address

245 W BADILLO ST STE E
COVINA CA
91723-1923
US

V. Phone/Fax

Practice location:
  • Phone: 626-967-6461
  • Fax: 626-332-4264
Mailing address:
  • Phone: 626-967-6461
  • Fax: 626-332-4264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: