Healthcare Provider Details

I. General information

NPI: 1669560371
Provider Name (Legal Business Name): YEAGER & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 LA JOLLA VILLAGE DR
LA JOLLA CA
92037-1406
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 800-883-7243
  • Fax:
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC36677
License Number StateCA

VIII. Authorized Official

Name: DR. DOUGLAS WEMMER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243