Provider Demographics
NPI:1205279064
Name:BARONE HERNANDEZ, YOEL EDUARDO (IDC)
Entity type:Individual
Prefix:
First Name:YOEL
Middle Name:EDUARDO
Last Name:BARONE HERNANDEZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 TRIDENT WAY
Mailing Address - Street 2:BLDG 616
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92155-5492
Mailing Address - Country:US
Mailing Address - Phone:619-537-3756
Mailing Address - Fax:619-437-5120
Practice Address - Street 1:2642 TRIDENT WAY
Practice Address - Street 2:BLDG 616
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5492
Practice Address - Country:US
Practice Address - Phone:619-537-3756
Practice Address - Fax:619-437-5120
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman