Healthcare Provider Details

I. General information

NPI: 1205170339
Provider Name (Legal Business Name): YAMILAH BUBAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N 11TH ST
SAN JOSE CA
95112-3427
US

IV. Provider business mailing address

114 N 11TH ST
SAN JOSE CA
95112-3427
US

V. Phone/Fax

Practice location:
  • Phone: 408-396-3091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: