Healthcare Provider Details

I. General information

NPI: 1235261306
Provider Name (Legal Business Name): DISAN FLORES YAP APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E LEGACY DR
MOUNTAIN HOUSE CA
95391-1015
US

IV. Provider business mailing address

431 E LEGACY DR
MOUNTAIN HOUSE CA
95391-1015
US

V. Phone/Fax

Practice location:
  • Phone: 510-364-7374
  • Fax: 209-839-0119
Mailing address:
  • Phone: 510-364-7374
  • Fax: 209-839-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: