MEDICARE: DR. REGINALD WOODROW YESKE

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
1	207Q00000X	Family Medicine Physician	BY8095538	CA

General Provider Information

NPI Number	:	1114037330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINALD WOODROW YESKE

Provider Business Mailing Address
First Line	:	1190 N STUDEBAKER RD STE H
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4968
Country	:	US
Telephone Number	:	562-597-9402
Fax Number	:	562-498-5802

Provider Business Practice Location Address
First Line	:	1190 N STUDEBAKER RD STE H
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-4968
Country	:	US
Telephone Number	:	562-597-9402
Fax Number	:	562-498-5802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/07/2020

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