Healthcare Provider Details

I. General information

NPI: 1942576772
Provider Name (Legal Business Name): JACQUELINE YANO MAHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE CARLA YANO M.D.

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S LAKE AVE FL 9
PASADENA CA
91101-2676
US

IV. Provider business mailing address

2020 ZONAL AVE STE IRD534
LOS ANGELES CA
90089-0121
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-3026
  • Fax:
Mailing address:
  • Phone: 323-409-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD047567
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberC203001
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35.154161
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberD0081327
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number336128
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: