Healthcare Provider Details

I. General information

NPI: 1053481283
Provider Name (Legal Business Name): MS. MARILYN C YEATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 SUNRISE #120
ROSEVILLE CA
95661
US

IV. Provider business mailing address

775 SUNRISE #120
ROSEVILLE CA
95661
US

V. Phone/Fax

Practice location:
  • Phone: 916-786-3416
  • Fax: 916-773-0965
Mailing address:
  • Phone: 916-786-3416
  • Fax: 916-773-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS11788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: