Healthcare Provider Details

I. General information

NPI: 1467663799
Provider Name (Legal Business Name): KELLY YABLONSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 S J STOCK RD
TUCSON AZ
85746-7012
US

IV. Provider business mailing address

5952 E 18TH ST
TUCSON AZ
85711-4623
US

V. Phone/Fax

Practice location:
  • Phone: 520-295-2482
  • Fax: 520-295-2690
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38058
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: