Healthcare Provider Details

I. General information

NPI: 1114864055
Provider Name (Legal Business Name): YEALEM LLC DBA MISSION VILLA EAST, MISSION VILLA WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7241 ZEST ST
SAN DIEGO CA
92139-1253
US

IV. Provider business mailing address

7241 ZEST ST
SAN DIEGO CA
92139-1253
US

V. Phone/Fax

Practice location:
  • Phone: 619-757-9519
  • Fax: 619-757-9519
Mailing address:
  • Phone: 619-757-9519
  • Fax: 619-757-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: AMSAL ENGDAW
Title or Position: MANAGING MEMBER
Credential:
Phone: 619-757-9519