Provider Demographics
NPI:1235376518
Name:FARRELL, YVONNE R (LAC, DAOM)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:R
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2990 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-0002
Mailing Address - Country:US
Mailing Address - Phone:310-387-8914
Mailing Address - Fax:310-492-5185
Practice Address - Street 1:2990 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-0002
Practice Address - Country:US
Practice Address - Phone:310-387-8914
Practice Address - Fax:310-492-5185
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC5578171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist