=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619971439
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YASH P VERMA MD, MPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 01/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1850 WHITSON ST
-----------------------------------------------------
City | SELMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93662-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-896-1414
-----------------------------------------------------
Fax | 559-896-5082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1850 WHITSON ST
-----------------------------------------------------
City | SELMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93662-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-896-1414
-----------------------------------------------------
Fax | 559-896-5082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | C39061
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | C39061
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | C39061
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------