Provider Demographics
NPI:1811043474
Name:YARBROUGH, CLARA (PA)
Entity Type:Individual
Prefix:MS
First Name:CLARA
Middle Name:
Last Name:YARBROUGH
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 1:3920 EAGLE ROCK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3606
Mailing Address - Country:US
Mailing Address - Phone:323-255-5225
Mailing Address - Fax:
Practice Address - Street 1:3920 EAGLE ROCK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3606
Practice Address - Country:US
Practice Address - Phone:323-255-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB217375Medicare UPIN