Provider Demographics
NPI:1558375485
Name:YARIS, JACQUELINE E (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:YARIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9725 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2002
Mailing Address - Country:US
Mailing Address - Phone:323-305-7150
Mailing Address - Fax:323-305-7149
Practice Address - Street 1:9725 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2002
Practice Address - Country:US
Practice Address - Phone:323-305-7150
Practice Address - Fax:323-305-7149
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38593Medicare UPIN