Provider Demographics
NPI:1790864478
Name:GRELL, YOLANDA Z (PA)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:Z
Last Name:GRELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 E COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3307
Mailing Address - Country:US
Mailing Address - Phone:310-635-8006
Mailing Address - Fax:310-635-4910
Practice Address - Street 1:1145 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3307
Practice Address - Country:US
Practice Address - Phone:310-635-8006
Practice Address - Fax:310-635-4910
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11306363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP56050Medicare UPIN