Basic Information
| Provider Information | |||||||||
| NPI: | 1053543009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASANNAT | ||||||||
| FirstName: | YANAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2270 S RIDGEVIEW DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853648875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287823098 | ||||||||
| FaxNumber: | 9287823251 | ||||||||
| Practice Location | |||||||||
| Address1: | 2851 S AVENUE B BLDG 20 | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283362434 | ||||||||
| FaxNumber: | 9283362435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2009 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 48419 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.