Provider Demographics
NPI:1710197447
Name:YATES, TODD JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:JAMES
Last Name:YATES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:805-485-8709
Mailing Address - Fax:805-485-5521
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-485-8709
Practice Address - Fax:805-485-5521
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10187207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710197447Medicaid
5628497OtherNCPDP/NPDS
CE294ZMedicare PIN
1028830001Medicare NSC
CE294Medicare PIN