Healthcare Provider Details

I. General information

NPI: 1245848811
Provider Name (Legal Business Name): MICHELLE RUTH YEHIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 34TH ST
BAKERSFIELD CA
93301-2237
US

IV. Provider business mailing address

11471 GAYLAN AVE
WASCO CA
93280-9608
US

V. Phone/Fax

Practice location:
  • Phone: 661-428-9213
  • Fax:
Mailing address:
  • Phone: 661-428-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number771491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: