Provider Demographics
NPI:1902404767
Name:YANG, BELLA
Entity type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:YANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 OTAY LAKES RD # 270
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1364
Mailing Address - Country:US
Mailing Address - Phone:619-546-0039
Mailing Address - Fax:619-546-0037
Practice Address - Street 1:2060 OTAY LAKES RD # 270
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1364
Practice Address - Country:US
Practice Address - Phone:619-546-0039
Practice Address - Fax:619-546-0037
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist