Healthcare Provider Details

I. General information

NPI: 1063211167
Provider Name (Legal Business Name): YULISA BECERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 RUNNYMEDE ST
VAN NUYS CA
91405-1435
US

IV. Provider business mailing address

537 EVERGREEN ST APT 6
INGLEWOOD CA
90302-7068
US

V. Phone/Fax

Practice location:
  • Phone: 818-389-1184
  • Fax:
Mailing address:
  • Phone: 323-975-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberY2649484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: