Healthcare Provider Details

I. General information

NPI: 1265620405
Provider Name (Legal Business Name): NADINE H. YASSA, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 RESERVE DR SUITE A
ROSEVILLE CA
95678-1350
US

IV. Provider business mailing address

991 RESERVE DR SUITE A
ROSEVILLE CA
95678-1350
US

V. Phone/Fax

Practice location:
  • Phone: 916-789-8811
  • Fax: 916-789-8809
Mailing address:
  • Phone: 916-789-8811
  • Fax: 916-789-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NADINE H YASSA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 916-789-8811