Provider Demographics
NPI:1982338422
Name:PASAY, YOLANDA LIWANAG
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:LIWANAG
Last Name:PASAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 ELLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1807
Mailing Address - Country:US
Mailing Address - Phone:213-573-5128
Mailing Address - Fax:
Practice Address - Street 1:4911 ELLENWOOD DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1807
Practice Address - Country:US
Practice Address - Phone:213-573-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86197OtherCALIFORNIA STATE BOARD OF PHARMACY