Healthcare Provider Details

I. General information

NPI: 1437782869
Provider Name (Legal Business Name): CURTIS YARBROUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BIMINI PL
LOS ANGELES CA
90004-5902
US

IV. Provider business mailing address

155 BIMINI PL
LOS ANGELES CA
90004-5902
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-5423
  • Fax:
Mailing address:
  • Phone: 213-388-5423
  • Fax: 213-388-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1376970120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: