Healthcare Provider Details

I. General information

NPI: 1811563802
Provider Name (Legal Business Name): DESIREE LORRAINE YLLAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 S PACIFIC COAST HWY STE 205
REDONDO BEACH CA
90277-7036
US

IV. Provider business mailing address

1821 BELMONT LN APT A
REDONDO BEACH CA
90278-4154
US

V. Phone/Fax

Practice location:
  • Phone: 424-262-3107
  • Fax:
Mailing address:
  • Phone: 408-429-9793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34618
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number00207166
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number34618
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number33618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: