MEDICARE: MRS. YVONNE DECASTRO FERMIL 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	163W00000X	Registered Nurse	RN525830	CA
2	207Q00000X	Family Medicine Physician	11786	CA
3	363LF0000X	Family Nurse Practitioner	FNP11786	CA

General Provider Information

NPI Number	:	1518086388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVONNE DECASTRO FERMIL FNP

Provider Business Mailing Address
First Line	:	292 EUCLID AVE STE 115
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-3629
Country	:	US
Telephone Number	:	619-266-3332
Fax Number	:

Provider Business Practice Location Address
First Line	:	292 EUCLID AVE STE 115
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-3629
Country	:	US
Telephone Number	:	619-266-3332
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	06/13/2024

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