MEDICARE: DR. Y'SHUA YISRAEL

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	231H00000X	Audiologist	2300	LA

General Provider Information

NPI Number	:	1568797207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. Y'SHUA YISRAEL

Provider Business Mailing Address
First Line	:	9500 MONTGOMERY BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 MONTGOMERY BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2501
Country	:	US
Telephone Number	:	505-247-4224
Fax Number	:

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

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	10/14/2009

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