Provider Demographics
NPI:1952425316
Name:MICKEVICIUS RUOKIS, YOLANDA A (MD)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:A
Last Name:MICKEVICIUS RUOKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5500 UNIVERSITY PARKWAY
Mailing Address - Street 2:CALIFORNIA STATE UNIVERSITY SAN BERNARDINO STUDENT HLTH
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-2397
Mailing Address - Country:US
Mailing Address - Phone:909-537-3295
Mailing Address - Fax:909-537-7027
Practice Address - Street 1:5500 UNIVERSITY PARKWAY
Practice Address - Street 2:CALIFORNIA STATE UNIVERSITY SAN BERNARDINO STUDENT HLTH
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2397
Practice Address - Country:US
Practice Address - Phone:909-537-3295
Practice Address - Fax:909-537-7027
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC41204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine