Provider Demographics
NPI:1578817714
Name:SIAS, YVONNE FOUNTAINE (CRNA)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:FOUNTAINE
Last Name:SIAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 S SHENANDOAH ST
Mailing Address - Street 2:APT 8
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1220
Mailing Address - Country:US
Mailing Address - Phone:310-508-9180
Mailing Address - Fax:
Practice Address - Street 1:2031 S SHENANDOAH ST
Practice Address - Street 2:APT 8
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1220
Practice Address - Country:US
Practice Address - Phone:310-508-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267424163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care