Healthcare Provider Details

I. General information

NPI: 1063490613
Provider Name (Legal Business Name): MRS. YOLANDER DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NHCP, BLDG H100, SANTA MARGARITA RD, ATT: CODE 094
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

NHCP, BLDG H100, SANTA MARGARITA RD, ATT: CODE 094
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1335
  • Fax:
Mailing address:
  • Phone: 760-725-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: