Healthcare Provider Details

I. General information

NPI: 1417722786
Provider Name (Legal Business Name): PEPPINA JOY YEGOYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16030 VENTURA BLVD STE 110
ENCINO CA
91436-2775
US

IV. Provider business mailing address

16030 VENTURA BLVD STE 110
ENCINO CA
91436-2775
US

V. Phone/Fax

Practice location:
  • Phone: 747-224-2227
  • Fax: 818-471-4001
Mailing address:
  • Phone: 747-224-2227
  • Fax: 818-471-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: