Healthcare Provider Details

I. General information

NPI: 1063790970
Provider Name (Legal Business Name): THERESA CHUA YEOMANS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA THERESA CHUA NP

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-2641
  • Fax: 310-423-2356
Mailing address:
  • Phone: 310-423-2641
  • Fax: 310-423-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number20200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: