Healthcare Provider Details

I. General information

NPI: 1295613966
Provider Name (Legal Business Name): ANTHONY JAMES YEARTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5178 ATLANTIC AVE
LONG BEACH CA
90805-6510
US

IV. Provider business mailing address

11750 EUCLID ST APT 102
GARDEN GROVE CA
92840-2241
US

V. Phone/Fax

Practice location:
  • Phone: 562-218-1868
  • Fax:
Mailing address:
  • Phone: 714-819-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1434100326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: