Healthcare Provider Details

I. General information

NPI: 1699950394
Provider Name (Legal Business Name): YUMA NEUROLOGICAL ASSOCIATES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2008
Last Update Date: 01/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 S ELKS LN
YUMA AZ
85364-6258
US

IV. Provider business mailing address

2295 S ELKS LN
YUMA AZ
85364-6258
US

V. Phone/Fax

Practice location:
  • Phone: 928-783-0092
  • Fax: 928-782-1386
Mailing address:
  • Phone: 928-783-0092
  • Fax: 928-782-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37868
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number37868
License Number StateAZ

VIII. Authorized Official

Name: CHARLES H OLIVERA
Title or Position: PRESIDENT
Credential: MD
Phone: 928-783-0092