Healthcare Provider Details

I. General information

NPI: 1699475962
Provider Name (Legal Business Name): KEREM RIZA YILMAZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY
RIVERSIDE CA
92505-8510
US

IV. Provider business mailing address

23291 EAGLE RDG
MISSION VIEJO CA
92692-1697
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-3672
  • Fax:
Mailing address:
  • Phone: 949-235-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: