Provider Demographics
NPI:1154688604
Name:QUERUBIN, JYES ANNEMARIE (MD)
Entity Type:Individual
Prefix:
First Name:JYES
Middle Name:ANNEMARIE
Last Name:QUERUBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:630 S RAYMOND AVE UNIT 310
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3206
Mailing Address - Country:US
Mailing Address - Phone:626-598-3770
Mailing Address - Fax:626-598-3797
Practice Address - Street 1:630 S RAYMOND AVE UNIT 310
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3206
Practice Address - Country:US
Practice Address - Phone:626-598-3770
Practice Address - Fax:626-598-3797
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083335A2084N0402X
MTMED-PHYS-LIC-796622084N0402X
NC2023-029022084N0402X
CAA1317042084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology