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General NPI Number Information
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NPI Number | 1811563802
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Entity Type | Individual
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Provider Name | DESIREE LORRAINE YLLAN DC
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Gender | Female
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 234 S PACIFIC COAST HWY STE 205
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City | REDONDO BEACH
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State | CA
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Zip | 90277-7036
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Country | US
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Telephone | 424-262-3107
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 BELMONT LN APT A
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City | REDONDO BEACH
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State | CA
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Zip | 90278-4154
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Country | US
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Telephone | 408-429-9793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 34618
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number | 00207166
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 34618
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 33618
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License Number State | CA
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