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NPI Code Detail

MEDICARE: MISS YLIANA PENALOSA NP

MEDICARE: MISS YLIANA PENALOSA NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner95012667CA

General Provider Information

NPI Number : 1053980052
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS YLIANA PENALOSA NP
Provider Business Mailing Address
First Line : 1736 W MONTECITO WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-1263
Country : US
Telephone Number : 619-254-6669
Fax Number :
Provider Business Practice Location Address
First Line : 7755 CENTER AVE STE 630
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92647-9152
Country : US
Telephone Number : 657-237-2450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2021
Last Update Date : 04/12/2023

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