Provider Demographics
NPI:1811563802
Name:YLLAN, DESIREE LORRAINE (DC)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:LORRAINE
Last Name:YLLAN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 BELMONT LN APT A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4154
Mailing Address - Country:US
Mailing Address - Phone:408-429-9793
Mailing Address - Fax:
Practice Address - Street 1:234 S PACIFIC COAST HWY STE 205
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-7036
Practice Address - Country:US
Practice Address - Phone:424-262-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34618111N00000X, 111NR0400X
CA00207166111NR0200X
CA33618111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation