Provider Demographics
NPI:1366624090
Name:YU, XIAOXIA
Entity Type:Individual
Prefix:
First Name:XIAOXIA
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24414 UNIVERSITY AVE SPC 2
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2647
Mailing Address - Country:US
Mailing Address - Phone:909-796-6567
Mailing Address - Fax:
Practice Address - Street 1:24414 UNIVERSITY AVE SPC 2
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2647
Practice Address - Country:US
Practice Address - Phone:909-796-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593924363LF0000X
CANP17865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
BI910ZMedicare PIN
CABJ090YMedicare PIN
CABJ090ZMedicare PIN