Healthcare Provider Details

I. General information

NPI: 1124152178
Provider Name (Legal Business Name): RICHARD LESTER YUKL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24382 LAWTON AVE
LOMA LINDA CA
92354-3338
US

IV. Provider business mailing address

PO BOX 1159
LOMA LINDA CA
92354-1159
US

V. Phone/Fax

Practice location:
  • Phone: 909-796-6472
  • Fax: 909-796-6472
Mailing address:
  • Phone: 909-796-6472
  • Fax: 909-796-6472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG87341
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35878
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: