Provider Demographics
NPI:1780364661
Name:YORBA, AYESHA TAJ
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:TAJ
Last Name:YORBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AYESHA
Other - Middle Name:TAJ
Other - Last Name:RAZACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2717 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2442
Mailing Address - Country:US
Mailing Address - Phone:407-404-2197
Mailing Address - Fax:
Practice Address - Street 1:2717 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2442
Practice Address - Country:US
Practice Address - Phone:323-435-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist