=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154584449
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIANA MARIN YATES MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2008
-----------------------------------------------------
Last Update Date | 08/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 THUNDERBIRD DR STE E
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79912-4570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-566-9369
-----------------------------------------------------
Fax | 915-566-8120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 529 LINDBERGH AVE
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79932-2529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-409-9253
-----------------------------------------------------
Fax | 915-566-8120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | MD.207546
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | P1356
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------