Provider Demographics
NPI:1982829016
Name:CARRERA, YOLANDA MATAYOSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:MATAYOSHI
Last Name:CARRERA
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 1:1757 ROUTE 16
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HARMON
Mailing Address - State:GU
Mailing Address - Zip Code:96929
Mailing Address - Country:US
Mailing Address - Phone:671-649-1058
Mailing Address - Fax:671-649-1057
Practice Address - Street 1:1757 ROUTE 16
Practice Address - Street 2:SUITE 109
Practice Address - City:HARMON
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-649-1058
Practice Address - Fax:671-649-1057
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM000768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU055Medicaid
GU055Medicaid