Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 519882 | CA |
NPI | 1003041161 |
---|---|
Provider Name | Susan Kermoian Yaszay |
First Address | San Diego, CA 92102-4541 |
Second Address | San Diego, CA 92102-4541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 19/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
UPIN | W5352 (01) | CA |