Provider Demographics
NPI:1164634127
Name:TSO, YOLANDA (MD)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:TSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:TSO
Other - Last Name:BACA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:401 SAN MATEO BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2921
Mailing Address - Country:US
Mailing Address - Phone:505-462-7333
Mailing Address - Fax:
Practice Address - Street 1:401 SAN MATEO BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2921
Practice Address - Country:US
Practice Address - Phone:505-462-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0303208000000X
CAA94447208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics