Provider Demographics
NPI:1457682163
Name:RICCI-YUSTER, EVELINA (RPT)
Entity Type:Individual
Prefix:
First Name:EVELINA
Middle Name:
Last Name:RICCI-YUSTER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:EVELINA
Other - Middle Name:
Other - Last Name:RICCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10061 RIVERSIDE DR STE 271
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2560
Mailing Address - Country:US
Mailing Address - Phone:323-394-3861
Mailing Address - Fax:
Practice Address - Street 1:10061 RIVERSIDE DR STE 271
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2560
Practice Address - Country:US
Practice Address - Phone:323-394-3861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223122251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics