Healthcare Provider Details

I. General information

NPI: 1235309980
Provider Name (Legal Business Name): DR. MICHAEL YAVROM DPM PODIATRIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 08/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR STE 1
MOUNTAIN VIEW CA
94040-4106
US

IV. Provider business mailing address

2500 HOSPITAL DR STE 1
MOUNTAIN VIEW CA
94040-4106
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-1995
  • Fax: 650-961-2781
Mailing address:
  • Phone: 650-961-1995
  • Fax: 650-961-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1204
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL YAVROM
Title or Position: OWNER
Credential: DPM
Phone: 650-961-1995