Provider Demographics
NPI:1083588651
Name:RICHESON, YOLANDA
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:RICHESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ARENA ST STE A
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3932
Mailing Address - Country:US
Mailing Address - Phone:310-424-8664
Mailing Address - Fax:
Practice Address - Street 1:824 E GRAND AVE APT 6
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4135
Practice Address - Country:US
Practice Address - Phone:310-424-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA641712083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports MedicineGroup - Multi-Specialty