Provider Demographics
NPI:1679792733
Name:ULREY, YADIRA R (PA)
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:R
Last Name:ULREY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4795
Mailing Address - Country:US
Mailing Address - Phone:619-409-9999
Mailing Address - Fax:619-409-9905
Practice Address - Street 1:165 S 1ST ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4795
Practice Address - Country:US
Practice Address - Phone:619-409-9999
Practice Address - Fax:619-409-9905
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18231363A00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18231OtherLICENCE #