Healthcare Provider Details

I. General information

NPI: 1013632272
Provider Name (Legal Business Name): YARA CHIHA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/09/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 ROYAL AVE, STE 234
SIMI VALLEY CA
93065
US

IV. Provider business mailing address

11663 FLORENCIA LN
PORTER RANCH CA
91326-4608
US

V. Phone/Fax

Practice location:
  • Phone: 55-271-4178
  • Fax: 805-584-2477
Mailing address:
  • Phone: 818-456-7567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: