MEDICARE: DR. RONALD BRADFIELD YATES JR. PH.D.

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	103TC0700X	Clinical Psychologist	PSY13327	CA

General Provider Information

NPI Number	:	1881633618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD BRADFIELD YATES JR. PH.D.

Provider Business Mailing Address
First Line	:	12625 HIGH BLUFF DR
Second Line	:	SUITE 206
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2052
Country	:	US
Telephone Number	:	858-793-1855
Fax Number	:

Provider Business Practice Location Address
First Line	:	12625 HIGH BLUFF DR
Second Line	:	SUITE 206
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2052
Country	:	US
Telephone Number	:	858-793-1855
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	12/08/2011

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