Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A157257 | CA |
NPI | 1083142582 |
---|---|
Provider Name | Dr. Marisa Yanez Jayakar |
First Address | San Jose, CA 95128-1632 |
Second Address | San Jose, CA 95128-1632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2017 |
Last Update Date | 08/09/2020 |