Provider Demographics
NPI:1881633618
Name:YATES, RONALD BRADFIELD JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BRADFIELD
Last Name:YATES
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 HIGH BLUFF DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2052
Mailing Address - Country:US
Mailing Address - Phone:858-793-1855
Mailing Address - Fax:
Practice Address - Street 1:12625 HIGH BLUFF DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2052
Practice Address - Country:US
Practice Address - Phone:858-793-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13327103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY13327Medicare ID - Type UnspecifiedINDIVIDUAL ID