Healthcare Provider Details

I. General information

NPI: 1255014353
Provider Name (Legal Business Name): YALDA GHADER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

220 MIRA MAR AVE APT C
LONG BEACH CA
90803-6163
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8960
  • Fax:
Mailing address:
  • Phone: 909-472-1864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95026541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: