Healthcare Provider Details

I. General information

NPI: 1720156722
Provider Name (Legal Business Name): PACITO V YABES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 BARONESS WAY
ROSEVILLE CA
95747
US

IV. Provider business mailing address

1705 BARONESS WAY
ROSEVILLE CA
95747-5029
US

V. Phone/Fax

Practice location:
  • Phone: 916-258-3528
  • Fax:
Mailing address:
  • Phone: 916-258-3528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA83769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: