Healthcare Provider Details

I. General information

NPI: 1114941218
Provider Name (Legal Business Name): JOSE JUMIL YONGCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 CENTERPOINTE PKWY
SANTA MARIA CA
93455-1334
US

IV. Provider business mailing address

1026 HENRY AVE APT A
SANTA MARIA CA
93455-8406
US

V. Phone/Fax

Practice location:
  • Phone: 805-346-7230
  • Fax: 805-346-7272
Mailing address:
  • Phone: 805-937-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA92321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: