Healthcare Provider Details

I. General information

NPI: 1114852498
Provider Name (Legal Business Name): KHALEHLA YNOSTROZA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NORDAHL RD APT A
SAN MARCOS CA
92069-3547
US

IV. Provider business mailing address

815 NORDAHL RD APT A
SAN MARCOS CA
92069-3547
US

V. Phone/Fax

Practice location:
  • Phone: 661-345-7339
  • Fax:
Mailing address:
  • Phone: 661-345-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number310136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: