Provider Demographics
NPI:1689607053
Name:TELGT-MCKINNEY, YVONNE R (MD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:R
Last Name:TELGT-MCKINNEY
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 1:16519 VICTOR ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3965
Mailing Address - Country:US
Mailing Address - Phone:760-955-9555
Mailing Address - Fax:760-955-8558
Practice Address - Street 1:16519 VICTOR ST
Practice Address - Street 2:SUITE 307
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3965
Practice Address - Country:US
Practice Address - Phone:760-955-9555
Practice Address - Fax:760-955-8558
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A876661Medicare ID - Type Unspecified
CAI17460Medicare UPIN