Healthcare Provider Details

I. General information

NPI: 1487943551
Provider Name (Legal Business Name): ELIZA YACCOBE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10780 SANTA MONICA BLVD STE 320
LOS ANGELES CA
90025
US

IV. Provider business mailing address

3757 COLDSTREAM TER
TARZANA CA
91356-5613
US

V. Phone/Fax

Practice location:
  • Phone: 424-320-4884
  • Fax:
Mailing address:
  • Phone: 310-995-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number692631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: