MEDICARE: ANITA MARIE YDROGO

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	405300000X	Prevention Professional	70004352735	CA

General Provider Information

NPI Number	:	1871423293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA MARIE YDROGO

Provider Business Mailing Address
First Line	:	6109 MUSTANG PL
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-3673
Country	:	US
Telephone Number	:	350-231-3856
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N STANISLAUS ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95202-2949
Country	:	US
Telephone Number	:	350-231-3856
Fax Number	:

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

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “ ANITA MARIE YDROGO ” Practice Location

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