Healthcare Provider Details

I. General information

NPI: 1831131085
Provider Name (Legal Business Name): RICK A YAVRUIAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N ALUMBAUGH ST
BOISE ID
83704-9204
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-2175
  • Fax: 208-376-0285
Mailing address:
  • Phone: 208-367-2175
  • Fax: 208-376-0285

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:
Title or Position:
Credential:
Phone: