Healthcare Provider Details

I. General information

NPI: 1235909615
Provider Name (Legal Business Name): ROBERT YANG CCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 ENCINITAS BLVD STE 119
ENCINITAS CA
92024-3781
US

IV. Provider business mailing address

1486 BOTTLE TREE LN
ENCINITAS CA
92024-1500
US

V. Phone/Fax

Practice location:
  • Phone: 760-815-2618
  • Fax:
Mailing address:
  • Phone: 760-815-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number6041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: