Provider Demographics
NPI:1619049129
Name:YASHAR, CATHERYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERYN
Middle Name:M
Last Name:YASHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 HEALTH SCIENCES DR # 0843
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0843
Mailing Address - Country:US
Mailing Address - Phone:858-822-6055
Mailing Address - Fax:619-543-3183
Practice Address - Street 1:3855 HEALTH SCIENCES DR # 0843
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0843
Practice Address - Country:US
Practice Address - Phone:858-822-6055
Practice Address - Fax:619-543-3183
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG819182085R0001X
KY321812085R0001X
IN01046843A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G819180Medicaid
CABG375ZMedicare PIN
H51175Medicare UPIN
CAWG81918AMedicare PIN