Provider Demographics
NPI:1780363531
Name:YADAO, ANNA LIZA
Entity type:Individual
Prefix:
First Name:ANNA LIZA
Middle Name:
Last Name:YADAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALAHATI
Other - Middle Name:
Other - Last Name:LACUESTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3241 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:931 SAN BRUNO AVE W RM 2
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3435
Practice Address - Country:US
Practice Address - Phone:650-832-6797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker