Basic Information
| Provider Information | |||||||||
| NPI: | 1093881245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YUSKAVAGE | ||||||||
| FirstName: | MARYBETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 28949 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937298949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592284200 | ||||||||
| FaxNumber: | 5592243920 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 W FIR AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936110223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592997294 | ||||||||
| FaxNumber: | 5592990641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G76356 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.