Provider Demographics
NPI:1053980052
Name:PENALOSA, YLIANA (NP)
Entity type:Individual
Prefix:MISS
First Name:YLIANA
Middle Name:
Last Name:PENALOSA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 W MONTECITO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1263
Mailing Address - Country:US
Mailing Address - Phone:619-254-6669
Mailing Address - Fax:
Practice Address - Street 1:7755 CENTER AVE STE 630
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9152
Practice Address - Country:US
Practice Address - Phone:657-237-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily