Healthcare Provider Details

I. General information

NPI: 1740327238
Provider Name (Legal Business Name): MANUEL YPINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 BIRCH ST
CALEXICO CA
92231
US

IV. Provider business mailing address

1263 A CN PERRY AVE
CALEXICO CA
92231
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-7790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number693368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: