Healthcare Provider Details

I. General information

NPI: 1972859080
Provider Name (Legal Business Name): OLIVIA YAMBEM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 LAKE HAVASU AVE S STE 202
LAKE HAVASU CITY AZ
86403-6526
US

IV. Provider business mailing address

330 SEVEN SPRINGS WAY
BRENTWOOD TN
37027-5098
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-1242
  • Fax: 928-854-1243
Mailing address:
  • Phone: 615-920-7743
  • Fax: 615-920-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number55485
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: