Provider Demographics
NPI:1114941218
Name:YONGCO, JOSE JUMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JUMIL
Last Name:YONGCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 HENRY AVE
Mailing Address - Street 2:APT A
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-8406
Mailing Address - Country:US
Mailing Address - Phone:805-937-2147
Mailing Address - Fax:
Practice Address - Street 1:2115 CENTERPOINTE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1334
Practice Address - Country:US
Practice Address - Phone:805-346-7230
Practice Address - Fax:805-346-7272
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92321OtherMED LICENSE
CA00A923210Medicaid
H70051Medicare UPIN
CA00A923210Medicaid