Healthcare Provider Details

I. General information

NPI: 1376210237
Provider Name (Legal Business Name): AYAA YESMINE KOBAISSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43112 15TH ST W
LANCASTER CA
93534-6219
US

IV. Provider business mailing address

8724 LUCIA PL
SUN VALLEY CA
91352-3457
US

V. Phone/Fax

Practice location:
  • Phone: 866-362-5488
  • Fax:
Mailing address:
  • Phone: 818-588-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: