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NPI Code Detail

MEDICARE: PRAVEENA YETUR MD

MEDICARE:   PRAVEENA  YETUR  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZC0500XCytopathology PhysicianA43640CA
2207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianA43640CA

General Provider Information

NPI Number : 1043279490
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRAVEENA YETUR MD
Provider Business Mailing Address
First Line : 925 E COLORADO BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91106-1721
Country : US
Telephone Number : 626-584-0718
Fax Number : 626-584-0873
Provider Business Practice Location Address
First Line : 250 S GRAND AVE
Second Line :
City : GLENDORA
State : CA
Zip : 91741-4218
Country : US
Telephone Number : 626-857-3201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2006
Last Update Date : 08/31/2016

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Directions to “ PRAVEENA YETUR MD” Practice Location

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