Healthcare Provider Details

I. General information

NPI: 1881380954
Provider Name (Legal Business Name): LAYLA YAGHOOBI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CALIFORNIA AVE
PALO ALTO CA
94306-1618
US

IV. Provider business mailing address

188 W SAINT JAMES ST UNIT 10916
SAN JOSE CA
95110-2569
US

V. Phone/Fax

Practice location:
  • Phone: 650-681-2900
  • Fax:
Mailing address:
  • Phone: 505-414-4790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number36652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: