MEDICARE: LI-YUN MA PMHNP-BC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95038946	CA

General Provider Information

NPI Number	:	1205783784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LI-YUN MA PMHNP-BC

Provider Business Mailing Address
First Line	:	2295 S VINEYARD AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-7925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 TRAILSIDE CIR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92881-6616
Country	:	US
Telephone Number	:	714-515-9362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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