Provider Demographics
NPI:1942784517
Name:YAMADA, RAEANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:RAEANNE
Middle Name:
Last Name:YAMADA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RAEANNE
Other - Middle Name:
Other - Last Name:QUARESMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 PERRIN RD
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8892
Mailing Address - Country:US
Mailing Address - Phone:209-679-5501
Mailing Address - Fax:
Practice Address - Street 1:1421 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3356
Practice Address - Country:US
Practice Address - Phone:209-572-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55883363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant