Healthcare Provider Details

I. General information

NPI: 1417683988
Provider Name (Legal Business Name): MARITES YAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 SIERRA KEYS DR
SIERRA MADRE CA
91024-1047
US

IV. Provider business mailing address

513 SIERRA KEYS DR
SIERRA MADRE CA
91024-1047
US

V. Phone/Fax

Practice location:
  • Phone: 626-826-5965
  • Fax:
Mailing address:
  • Phone: 626-826-5965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: