Provider Demographics
NPI:1770352718
Name:YEE, MAURINE ANGELA
Entity type:Individual
Prefix:
First Name:MAURINE
Middle Name:ANGELA
Last Name:YEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PEBBLES
Other - Middle Name:MAURINE
Other - Last Name:YEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:2305 W 29TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-2945
Mailing Address - Country:US
Mailing Address - Phone:310-402-7871
Mailing Address - Fax:
Practice Address - Street 1:2305 W 29TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-2945
Practice Address - Country:US
Practice Address - Phone:310-402-7871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health