Healthcare Provider Details

I. General information

NPI: 1497143929
Provider Name (Legal Business Name): YOLANDA ACLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 N FIGUEROA ST
LOS ANGELES CA
90065-3026
US

IV. Provider business mailing address

3918 EAGLE ROCK BLVD
LOS ANGELES CA
90065-3606
US

V. Phone/Fax

Practice location:
  • Phone: 323-223-3441
  • Fax:
Mailing address:
  • Phone: 818-539-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 18928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: