MEDICARE: YAZMIN CARBAJAL

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	E1466954	CA

General Provider Information

NPI Number	:	1568353803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAZMIN CARBAJAL

Provider Business Mailing Address
First Line	:	852 PALM DR
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-2557
Country	:	US
Telephone Number	:	909-442-8162
Fax Number	:

Provider Business Practice Location Address
First Line	:	852 PALM DR
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-2557
Country	:	US
Telephone Number	:	909-442-8162
Fax Number	:

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

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/14/2025

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Directions to “ YAZMIN CARBAJAL ” Practice Location

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