Provider Demographics
NPI:1407006273
Name:YANTO, LINSIE
Entity Type:Individual
Prefix:
First Name:LINSIE
Middle Name:
Last Name:YANTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINSIE
Other - Middle Name:
Other - Last Name:RUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22327 HOMESTEAD PLACE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350
Mailing Address - Country:US
Mailing Address - Phone:347-686-4588
Mailing Address - Fax:317-388-0805
Practice Address - Street 1:22327 HOMESTEAD PLACE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350
Practice Address - Country:US
Practice Address - Phone:347-686-4588
Practice Address - Fax:317-388-0805
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006827171W00000X
CA38425171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor