Healthcare Provider Details

I. General information

NPI: 1679410955
Provider Name (Legal Business Name): PATRICIA YSABELLE EUSALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13651 WILLARD ST
PANORAMA CITY CA
91402
US

IV. Provider business mailing address

13651 WILLARD ST
PANORAMA CITY CA
91402
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: