Healthcare Provider Details

I. General information

NPI: 1629386230
Provider Name (Legal Business Name): EDDIE YEE DESCALLAR NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WILSHIRE BLVD
LOS ANGELES CA
90057-3602
US

IV. Provider business mailing address

9547 VIA SALERNO
BURBANK CA
91504-1225
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-9934
  • Fax: 213-484-9939
Mailing address:
  • Phone: 818-489-2132
  • Fax: 818-252-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: