MEDICARE: MARYAM N YASSO FNP

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	363L00000X	Nurse Practitioner	95026507	CA

General Provider Information

NPI Number	:	1316724081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYAM N YASSO FNP

Provider Business Mailing Address
First Line	:	463 N MAGNOLIA AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3606
Country	:	US
Telephone Number	:	619-522-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	463 N MAGNOLIA AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3606
Country	:	US
Telephone Number	:	619-522-0399
Fax Number	:

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

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	05/03/2024

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