Provider Demographics
NPI:1093881245
Name:YUSKAVAGE, MARYBETH (MD)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:YUSKAVAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28949
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8949
Mailing Address - Country:US
Mailing Address - Phone:559-228-4200
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:221 W FIR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-0223
Practice Address - Country:US
Practice Address - Phone:559-299-7294
Practice Address - Fax:559-299-0641
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAG76356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E23201Medicare UPIN
CA00G763560Medicare ID - Type Unspecified