Healthcare Provider Details

I. General information

NPI: 1619053246
Provider Name (Legal Business Name): CHRISTINE RITA YACOUB PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2413 SPURGEON AVE
REDONDO BEACH CA
90278-1526
US

IV. Provider business mailing address

11301 WILSHIRE BLVD # 691/119
LOS ANGELES CA
90073-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-0709
  • Fax:
Mailing address:
  • Phone: 310-263-3461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: