Healthcare Provider Details

I. General information

NPI: 1053867721
Provider Name (Legal Business Name): CHASE YEATMAN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 N EL MOLINO AVE
PASADENA CA
91101-1403
US

IV. Provider business mailing address

130 N LOS ROBLES AVE APT 5
PASADENA CA
91101-1770
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-8480
  • Fax:
Mailing address:
  • Phone: 301-461-7597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: