Provider Demographics
NPI:1891976551
Name:YACOUBIAN, LEDA
Entity Type:Individual
Prefix:
First Name:LEDA
Middle Name:
Last Name:YACOUBIAN
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 1:5028 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4428
Mailing Address - Country:US
Mailing Address - Phone:818-514-6629
Mailing Address - Fax:
Practice Address - Street 1:2412 PICO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1827
Practice Address - Country:US
Practice Address - Phone:310-450-7624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist