Provider Demographics
NPI:1376730788
Name:WAFER, YOLANDA
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:WAFER
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 1:1525 WEBSTER STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533
Mailing Address - Country:US
Mailing Address - Phone:707-425-5028
Mailing Address - Fax:
Practice Address - Street 1:1525 WEBSTER ST
Practice Address - Street 2:SUITE E
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4997
Practice Address - Country:US
Practice Address - Phone:707-425-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter