MEDICARE: YSEMIA INGRAM

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1396453734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YSEMIA INGRAM

Provider Business Mailing Address
First Line	:	1680 N FAIR OAKS AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-1642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 E ARROW HWY
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-2535
Country	:	US
Telephone Number	:	661-860-3954
Fax Number	:

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

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	12/04/2025

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Directions to “ YSEMIA INGRAM ” Practice Location

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