Healthcare Provider Details

I. General information

NPI: 1174604953
Provider Name (Legal Business Name): PATRICK R YASSINI M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ORANGE AVE #100
CORONADO CA
92118-1408
US

IV. Provider business mailing address

131 ORANGE AVE #100
CORONADO CA
92118-1408
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-4005
  • Fax: 619-522-4014
Mailing address:
  • Phone: 619-522-4005
  • Fax: 619-522-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK YASSINI
Title or Position: OWNER
Credential: M.D.
Phone: 619-522-4005