Healthcare Provider Details

I. General information

NPI: 1164283768
Provider Name (Legal Business Name): MARY ANNE ROSE YEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CALIFORNIA AVE STE 100
PALO ALTO CA
94306-1607
US

IV. Provider business mailing address

1160 CHOPIN TER UNIT 302
FREMONT CA
94538-5621
US

V. Phone/Fax

Practice location:
  • Phone: 408-835-0358
  • Fax:
Mailing address:
  • Phone: 408-835-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number225400000X
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number373H00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: