Provider Demographics
NPI:1467658245
Name:SORENSON, YVONNE LIN (PA-C)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:LIN
Last Name:SORENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:I
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:361 3RD ST STE J
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3580
Mailing Address - Country:US
Mailing Address - Phone:154-757-6100
Mailing Address - Fax:
Practice Address - Street 1:361 3RD ST STE J
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3580
Practice Address - Country:US
Practice Address - Phone:415-757-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19168363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant