Healthcare Provider Details

I. General information

NPI: 1093881245
Provider Name (Legal Business Name): MARYBETH YUSKAVAGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W FIR AVE SUITE 101
CLOVIS CA
93611-0223
US

IV. Provider business mailing address

PO BOX 28949
FRESNO CA
93729-8949
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-7294
  • Fax: 559-299-0641
Mailing address:
  • Phone: 559-228-4200
  • Fax: 559-224-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG76356
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: