Provider Demographics
NPI:1164146700
Name:YA MEDICAL LLC
Entity Type:Organization
Organization Name:YA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:YURIY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:602-743-1741
Mailing Address - Street 1:334 W ANGELA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6526
Mailing Address - Country:US
Mailing Address - Phone:602-743-1741
Mailing Address - Fax:
Practice Address - Street 1:334 W ANGELA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6526
Practice Address - Country:US
Practice Address - Phone:602-743-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ135014Medicaid