=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881710440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN YVETTE SY D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 10/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24953 PASEO DE VALENCIA SUITE 1A
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-4342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-460-9200
-----------------------------------------------------
Fax | 949-470-9000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5430 AVENIDA DEL TREN
-----------------------------------------------------
City | YORBA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92887-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-489-7386
-----------------------------------------------------
Fax | 888-749-6344
-----------------------------------------------------
=====================================================
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 | 20A6587
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------