Healthcare Provider Details

I. General information

NPI: 1699697888
Provider Name (Legal Business Name): YSABEL MARIE FLORENDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YSABEL MARIE MEDINA FLORENDO

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 BROADWAY
MILLBRAE CA
94030-1909
US

IV. Provider business mailing address

12 SEVILLE CT
MILLBRAE CA
94030-1329
US

V. Phone/Fax

Practice location:
  • Phone: 650-697-0166
  • Fax: 650-697-7589
Mailing address:
  • Phone: 650-302-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: