Healthcare Provider Details

I. General information

NPI: 1124760194
Provider Name (Legal Business Name): YOELBIS ALCOLEA TAMAYO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E HERNDON AVE STE 105
FRESNO CA
93720-3306
US

IV. Provider business mailing address

1313 E HERNDON AVE STE 105
FRESNO CA
93720-3306
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-5372
  • Fax:
Mailing address:
  • Phone: 559-450-4637
  • Fax: 559-450-1437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPTL9550
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA197709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: