Healthcare Provider Details

I. General information

NPI: 1205677523
Provider Name (Legal Business Name): ELIEZER M YACHINI FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20046 BETZ DR
WINNETKA CA
91306-1107
US

IV. Provider business mailing address

20046 BETZ DR
WINNETKA CA
91306-1107
US

V. Phone/Fax

Practice location:
  • Phone: 661-916-5362
  • Fax:
Mailing address:
  • Phone: 661-916-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023210354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: