Healthcare Provider Details

I. General information

NPI: 1447392782
Provider Name (Legal Business Name): MRS. MYRNA DIAZ YEPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 SOUTH GRAND AVENUE
GLENDORA CA
91740
US

IV. Provider business mailing address

12412 BROADWAY AVE APT#4
WHITTIER CA
90601
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-5980
  • Fax: 626-335-5989
Mailing address:
  • Phone: 562-908-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: