Provider Demographics
NPI:1790048767
Name:MUDEY, YONIS A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:YONIS
Middle Name:A
Last Name:MUDEY
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2288 FULTON ST STE 309
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1490
Mailing Address - Country:US
Mailing Address - Phone:510-517-3156
Mailing Address - Fax:
Practice Address - Street 1:2288 FULTON ST STE 309
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1490
Practice Address - Country:US
Practice Address - Phone:650-577-2097
Practice Address - Fax:650-577-2098
Is Sole Proprietor?:No
Enumeration Date:2012-06-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21343363LA2200X, 363LF0000X, 363LP2300X, 363LP0808X
CA3467364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health