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General NPI Number Information
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NPI Number | 1710304514
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Entity Type | Organization
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Legal Business Name | YALDO EYE CENTER ASC LLC
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Dates
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Enumeration Date | 03/18/2014
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 2810 CAMINO DEL RIO S
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City | SAN DIEGO
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State | CA
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Zip | 92108-3818
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Country | US
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Telephone | 734-673-5917
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Fax | 314-667-6915
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Provider Business Mailing Address
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Address Line | 2810 CAMINO DEL RIO S
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City | SAN DIEGO
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State | CA
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Zip | 92108-3818
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Country | US
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Telephone | 734-673-5917
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Fax | 314-667-6915
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Authorized Official
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Title or Position | OWNER
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Name | MAZIN YALDO
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Credential | M.D.
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Telephone | 734-673-5917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 201332910064
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License Number State | CA
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