Healthcare Provider Details

I. General information

NPI: 1568191047
Provider Name (Legal Business Name): ISABEL YEE-LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 E CHAPMAN AVE
ORANGE CA
92869-3957
US

IV. Provider business mailing address

2179 HOFER DR
SAN DIEGO CA
92154-3069
US

V. Phone/Fax

Practice location:
  • Phone: 619-777-0699
  • Fax:
Mailing address:
  • Phone: 619-777-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberBU25R67
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: