Provider Demographics
NPI:1487270146
Name:YANOVER, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:YANOVER
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 1:27386 ONLEE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2138
Mailing Address - Country:US
Mailing Address - Phone:661-904-9746
Mailing Address - Fax:
Practice Address - Street 1:31575 VALLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-5500
Practice Address - Country:US
Practice Address - Phone:818-677-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer