Provider Demographics
NPI:1407275191
Name:YAZZIE, QUINTIN RYAN
Entity Type:Individual
Prefix:
First Name:QUINTIN
Middle Name:RYAN
Last Name:YAZZIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 E CORONADO RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4218
Mailing Address - Country:US
Mailing Address - Phone:928-637-3464
Mailing Address - Fax:
Practice Address - Street 1:4914 E CORONADO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4218
Practice Address - Country:US
Practice Address - Phone:928-637-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver