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General NPI Number Information
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NPI Number | 1881889145
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Entity Type | Individual
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Provider Name | VICENTA YASAY NP
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Gender | Female
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 3401 CENTRE LAKE DR STE 512
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City | ONTARIO
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State | CA
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Zip | 91761-1201
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Country | US
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Telephone | 909-566-0445
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Fax |
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Provider Business Mailing Address
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Address Line | 141 W FOOTHILL BLVD
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City | UPLAND
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State | CA
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Zip | 91786-8705
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Country | US
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Telephone | 909-296-8800
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Fax | 909-296-8928
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NP12870
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP12870
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License Number State | CA
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