Healthcare Provider Details

I. General information

NPI: 1629178439
Provider Name (Legal Business Name): JUDE BRIAN YLANAN R.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 W OLYMPIC BLVD
LOS ANGELES CA
90015-3806
US

IV. Provider business mailing address

1551 W OLYMPIC BLVD
LOS ANGELES CA
90015-3806
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-7478
  • Fax:
Mailing address:
  • Phone: 213-381-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: