Provider Demographics
NPI:1265620405
Name:NADINE H. YASSA, M.D., INC.
Entity type:Organization
Organization Name:NADINE H. YASSA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:YASSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-789-8811
Mailing Address - Street 1:991 RESERVE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-1350
Mailing Address - Country:US
Mailing Address - Phone:916-789-8811
Mailing Address - Fax:916-789-8809
Practice Address - Street 1:991 RESERVE DR
Practice Address - Street 2:SUITE A
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1350
Practice Address - Country:US
Practice Address - Phone:916-789-8811
Practice Address - Fax:916-789-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC6073OtherRAILROAD MEDICARE GROUP #
CADC6073OtherRAILROAD MEDICARE GROUP #