Provider Demographics
NPI:1932174612
Name:SLAYYEH, YASER A (MD)
Entity Type:Individual
Prefix:
First Name:YASER
Middle Name:A
Last Name:SLAYYEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3817
Mailing Address - Country:US
Mailing Address - Phone:909-882-3300
Mailing Address - Fax:909-882-3512
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:215
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3808
Practice Address - Country:US
Practice Address - Phone:909-882-3300
Practice Address - Fax:909-882-3512
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A560320Medicaid
CAF14240Medicare UPIN
CAZZZ29499ZMedicare ID - Type UnspecifiedMEDICARE