Healthcare Provider Details

I. General information

NPI: 1083142582
Provider Name (Legal Business Name): MARISA YANEZ JAYAKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2017
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LAWRENCE EXPY DEPT 498
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

710 LAWRENCE EXPY DEPT 498
SANTA CLARA CA
95051-5173
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-4137
  • Fax: 408-851-4149
Mailing address:
  • Phone: 408-851-4137
  • Fax: 408-851-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA157257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: