Provider Demographics
NPI:1750575874
Name:AGREDANO DE MORENO, YOLANDA ZAMORA (MD)
Entity type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:ZAMORA
Last Name:AGREDANO DE MORENO
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 1:614 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1048
Mailing Address - Country:US
Mailing Address - Phone:408-494-1561
Mailing Address - Fax:
Practice Address - Street 1:614 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1048
Practice Address - Country:US
Practice Address - Phone:408-494-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA964502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry