Healthcare Provider Details

I. General information

NPI: 1619665312
Provider Name (Legal Business Name): EDGAR GERONIMO YAP JR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDGAR GERONIMO YAP JR. MD

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9909 MIRA MESA BLVD STE 200
SAN DIEGO CA
92131-1061
US

IV. Provider business mailing address

9909 MIRA MESA BLVD STE 200
SAN DIEGO CA
92131-1061
US

V. Phone/Fax

Practice location:
  • Phone: 800-926-8273
  • Fax:
Mailing address:
  • Phone: 800-926-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA197205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: