=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417040361
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YVONNE RAMONA D'SYLVA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 MAGNOLIA AVE STE 2A
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92879-3122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-736-8144
-----------------------------------------------------
Fax | 951-736-8144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 770 MAGNOLIA AVE STE 2A
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92879-3122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-736-8144
-----------------------------------------------------
Fax | 951-736-0701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 00A353130
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------