Healthcare Provider Details

I. General information

NPI: 1164400933
Provider Name (Legal Business Name): YOLANDA REBOLLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 OLIVE ST.
LOS ANGELES CA
90015
US

IV. Provider business mailing address

1530 OLIVE ST.
LOS ANGELES CA
90015
US

V. Phone/Fax

Practice location:
  • Phone: 213-747-5542
  • Fax: 213-342-3416
Mailing address:
  • Phone: 213-747-5542
  • Fax: 213-342-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG65644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: