Healthcare Provider Details

I. General information

NPI: 1609404532
Provider Name (Legal Business Name): ALLYSON BROOKE YELICH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON BROOKE BRAHS

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20162 SW BIRCH ST STE 250
NEWPORT BEACH CA
92660-0797
US

IV. Provider business mailing address

2094 NATIONAL AVE
COSTA MESA CA
92627-3386
US

V. Phone/Fax

Practice location:
  • Phone: 949-251-0427
  • Fax: 949-251-0480
Mailing address:
  • Phone: 949-677-4301
  • Fax: 949-251-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20A-24778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: