Healthcare Provider Details

I. General information

NPI: 1255042180
Provider Name (Legal Business Name): DESSIELYN YU ROXAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESSIELYN ESPIRITU YU

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E AVENUE I
LANCASTER CA
93535-1916
US

IV. Provider business mailing address

335 E AVENUE I
LANCASTER CA
93535-1916
US

V. Phone/Fax

Practice location:
  • Phone: 661-471-4370
  • Fax:
Mailing address:
  • Phone: 661-471-4370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95180281
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: