Provider Demographics
NPI:1992719090
Name:YATES, ROBERTA C I (NP,RN)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:C
Last Name:YATES
Suffix:I
Gender:F
Credentials:NP,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:#20
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:818-265-2237
Mailing Address - Fax:818-265-2228
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:#250
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-265-2264
Practice Address - Fax:818-265-2263
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6309363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology