Provider Demographics
NPI:1457815227
Name:YADON, ANTHONY I
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:YADON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:YADON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:306 E MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2908
Mailing Address - Country:US
Mailing Address - Phone:209-478-4554
Mailing Address - Fax:
Practice Address - Street 1:306 E MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2908
Practice Address - Country:US
Practice Address - Phone:209-478-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician