Provider Demographics
NPI:1194516518
Name:ETSHALOM, YAAKOV NACHUM (EMT-B)
Entity type:Individual
Prefix:
First Name:YAAKOV
Middle Name:NACHUM
Last Name:ETSHALOM
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S DURANGO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4220
Mailing Address - Country:US
Mailing Address - Phone:310-598-8071
Mailing Address - Fax:
Practice Address - Street 1:1705 S DURANGO AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4220
Practice Address - Country:US
Practice Address - Phone:310-598-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY536561146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic