Healthcare Provider Details

I. General information

NPI: 1396106829
Provider Name (Legal Business Name): YIAYIAS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15886 INDIES CT
FOUNTAIN VALLEY CA
92708-1113
US

IV. Provider business mailing address

15886 INDIES CT
FOUNTAIN VALLEY CA
92708-1113
US

V. Phone/Fax

Practice location:
  • Phone: 714-274-2011
  • Fax:
Mailing address:
  • Phone: 714-274-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. CONSUELO FUTRIS
Title or Position: OWNER
Credential:
Phone: 631-336-7894