Provider Demographics
NPI:1750950952
Name:YLAUAN, JORDAN HERTZ (DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:HERTZ
Last Name:YLAUAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 GRAMERCY DR APT 602
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-3407
Mailing Address - Country:US
Mailing Address - Phone:818-309-8555
Mailing Address - Fax:
Practice Address - Street 1:3617 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5601
Practice Address - Country:US
Practice Address - Phone:213-935-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist