Healthcare Provider Details

I. General information

NPI: 1215365333
Provider Name (Legal Business Name): MARGARET M. YAGO, M.D., INC., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/31/2013
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

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

V. Phone/Fax

Practice location:
  • Phone: 949-719-3600
  • Fax: 949-644-7344
Mailing address:
  • Phone: 949-719-3600
  • Fax: 949-644-7344

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: MARGARET MARIE YAGO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-370-9629