Provider Demographics
NPI:1275661670
Name:CHENE, YASMIN (PA)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:CHENE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:YASMIN
Other - Middle Name:
Other - Last Name:BRACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10856 LORO VERDE AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:488 S K ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2641
Practice Address - Country:US
Practice Address - Phone:909-382-7180
Practice Address - Fax:909-382-7136
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMB1157735OtherDEA
CA0PA166110Medicare PIN
CAP78449Medicare UPIN