Healthcare Provider Details

I. General information

NPI: 1770504896
Provider Name (Legal Business Name): FREDERICK HARVEY YORRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18399 VENTURA BLVD SUITE 245
TARZANA CA
91356-4233
US

IV. Provider business mailing address

18399 VENTURA BLVD SUITE 245
TARZANA CA
91356-4233
US

V. Phone/Fax

Practice location:
  • Phone: 818-609-7536
  • Fax: 818-344-9670
Mailing address:
  • Phone: 818-609-7536
  • Fax: 818-344-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG16039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: