Healthcare Provider Details

I. General information

NPI: 1407072119
Provider Name (Legal Business Name): YOLANDA RENE TRAVIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 AUSTIN RD
STOCKTON CA
95215-8312
US

IV. Provider business mailing address

109 OAK CT
CHOWCHILLA CA
93610-9425
US

V. Phone/Fax

Practice location:
  • Phone: 209-467-2500
  • Fax:
Mailing address:
  • Phone: 415-305-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: