Healthcare Provider Details

I. General information

NPI: 1538907183
Provider Name (Legal Business Name): LORRE-ELIANA YNZON DAVID PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24301 MUIRLANDS BLVD STE T
LAKE FOREST CA
92630-3627
US

IV. Provider business mailing address

3230 E IMPERIAL HWY STE 100
BREA CA
92821-6735
US

V. Phone/Fax

Practice location:
  • Phone: 949-271-0012
  • Fax: 949-271-0013
Mailing address:
  • Phone: 714-256-5074
  • Fax: 714-256-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: