MEDICARE: JOANNE EPPS-YENTZ LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	280483	CA

General Provider Information

NPI Number	:	1073038527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE EPPS-YENTZ LVN

Provider Business Mailing Address
First Line	:	7414 MESA COLLEGE DR. APT 47
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111
Country	:	US
Telephone Number	:	858-722-8026
Fax Number	:	855-581-8047

Provider Business Practice Location Address
First Line	:	7414 MESA COLLEGE DR. APT 47
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111
Country	:	US
Telephone Number	:	858-722-8026
Fax Number	:	855-581-8047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2017
Last Update Date	:	08/06/2017

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