Provider Demographics
NPI:1124314018
Name:YODER, RANDI N
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:N
Last Name:YODER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 LYONCROSS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3421
Mailing Address - Country:US
Mailing Address - Phone:574-596-5237
Mailing Address - Fax:
Practice Address - Street 1:3789 HOOVER ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-4504
Practice Address - Country:US
Practice Address - Phone:650-363-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator