Healthcare Provider Details

I. General information

NPI: 1174680664
Provider Name (Legal Business Name): MARGARET MARIE YAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 AVOCADO AVE SUITE 100
NEWPORT BEACH CA
92660-7798
US

IV. Provider business mailing address

PO BOX 3447
FULLERTON CA
92834-3447
US

V. Phone/Fax

Practice location:
  • Phone: 949-719-3600
  • Fax: 949-644-7344
Mailing address:
  • Phone: 714-992-0850
  • Fax: 714-526-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG60680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: