Healthcare Provider Details

I. General information

NPI: 1174843973
Provider Name (Legal Business Name): ELIZABETH YIABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 LONG BEACH BLVD # IF
LONG BEACH CA
90807-3907
US

IV. Provider business mailing address

3505 LONG BEACH BLVD # IF
LONG BEACH CA
90807-3907
US

V. Phone/Fax

Practice location:
  • Phone: 562-988-3436
  • Fax: 562-988-3439
Mailing address:
  • Phone: 562-988-3436
  • Fax: 562-988-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: