Provider Demographics
NPI:1639474307
Name:YEZMAN, NICOLE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:YEZMAN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 OAK GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7021
Mailing Address - Country:US
Mailing Address - Phone:408-438-2402
Mailing Address - Fax:503-427-9770
Practice Address - Street 1:56 OAK GROVE AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7021
Practice Address - Country:US
Practice Address - Phone:408-438-2402
Practice Address - Fax:503-427-9770
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC153071171100000X
OR1810175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist