Provider Demographics
NPI:1447392782
Name:YEPEZ, MYRNA DIAZ
Entity Type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:DIAZ
Last Name:YEPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 BROADWAY AVE
Mailing Address - Street 2:APT#4
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601
Mailing Address - Country:US
Mailing Address - Phone:562-908-7131
Mailing Address - Fax:
Practice Address - Street 1:1160 SOUTH GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740
Practice Address - Country:US
Practice Address - Phone:626-335-5980
Practice Address - Fax:626-335-5989
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner