Healthcare Provider Details

I. General information

NPI: 1225859572
Provider Name (Legal Business Name): NYLA ASKEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 YANKEE JIM CT
VALLEJO CA
94589-1454
US

IV. Provider business mailing address

121 YANKEE JIM CT
VALLEJO CA
94589-1454
US

V. Phone/Fax

Practice location:
  • Phone: 510-435-4534
  • Fax:
Mailing address:
  • Phone: 510-435-4534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberY6328408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: