Healthcare Provider Details

I. General information

NPI: 1598758690
Provider Name (Legal Business Name): STEPHANIE S YAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR STE 205
RANCHO MIRAGE CA
92270-4150
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR STE 205
RANCHO MIRAGE CA
92270-4150
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-7900
  • Fax: 760-834-7901
Mailing address:
  • Phone: 760-834-7900
  • Fax: 760-834-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC52376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: