Healthcare Provider Details

I. General information

NPI: 1982829016
Provider Name (Legal Business Name): YOLANDA MATAYOSHI CARRERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 ROUTE 16 SUITE 109
HARMON GU
96929
US

IV. Provider business mailing address

1757 ROUTE 16 SUITE 109
HARMON GU
96929
US

V. Phone/Fax

Practice location:
  • Phone: 671-649-1058
  • Fax: 671-649-1057
Mailing address:
  • Phone: 671-649-1058
  • Fax: 671-649-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM000768
License Number StateGU

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier055
Identifier TypeMEDICAID
Identifier StateGU
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: