Healthcare Provider Details

I. General information

NPI: 1417379215
Provider Name (Legal Business Name): JANTEEN YEFTADOUNAEE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 W ALLUVIAL AVE SUITE 101
FRESNO CA
93711-5509
US

IV. Provider business mailing address

5820 BECKFORD AVE
TARZANA CA
91356-1103
US

V. Phone/Fax

Practice location:
  • Phone: 180-079-7354
  • Fax:
Mailing address:
  • Phone: 818-515-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: