Healthcare Provider Details

I. General information

NPI: 1285121830
Provider Name (Legal Business Name): YAVRUIAN ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 N ALLUMBAUGH ST STE 101
BOISE ID
83704-9219
US

IV. Provider business mailing address

413 N ALLUMBAUGH ST STE 101
BOISE ID
83704-9219
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-1125
  • Fax: 208-323-9604
Mailing address:
  • Phone: 208-323-1125
  • Fax: 208-323-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberO-243
License Number StateID

VIII. Authorized Official

Name: ALISON DUNBAR
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 208-954-5573