Healthcare Provider Details

I. General information

NPI: 1609603786
Provider Name (Legal Business Name): YESSUNI DEL ROCIO MARTINEZ UTRERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SW CARY PKWY STE 200
CARY NC
27511-6224
US

IV. Provider business mailing address

1515 SW CARY PKWY STE 200
CARY NC
27511-6224
US

V. Phone/Fax

Practice location:
  • Phone: 919-387-3176
  • Fax:
Mailing address:
  • Phone: 919-387-3176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14572
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: