MEDICARE: DR. OLIVIA YAMBEM M.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	2084N0400X	Neurology Physician	55485	AZ

General Provider Information

NPI Number	:	1972859080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVIA YAMBEM M.D.

Provider Business Mailing Address
First Line	:	330 SEVEN SPRINGS WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5098
Country	:	US
Telephone Number	:	615-920-7743
Fax Number	:	615-920-8775

Provider Business Practice Location Address
First Line	:	297 LAKE HAVASU AVE S STE 202
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6526
Country	:	US
Telephone Number	:	928-854-1242
Fax Number	:	928-854-1243

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

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	06/04/2026

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