Healthcare Provider Details

I. General information

NPI: 1881793685
Provider Name (Legal Business Name): LARA E YOBLONSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E VAN BUREN ST
PHOENIX AZ
85008-6812
US

IV. Provider business mailing address

3200 E CAMELBACK RD STE 250
PHOENIX AZ
85018-2327
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0945
  • Fax: 602-933-4263
Mailing address:
  • Phone: 602-933-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25745
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: