Provider Demographics
NPI:1124760194
Name:ALCOLEA TAMAYO, YOELBIS (MD)
Entity type:Individual
Prefix:
First Name:YOELBIS
Middle Name:
Last Name:ALCOLEA TAMAYO
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 1:1313 E HERNDON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3306
Mailing Address - Country:US
Mailing Address - Phone:559-450-4637
Mailing Address - Fax:559-450-1437
Practice Address - Street 1:1313 E HERNDON AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3306
Practice Address - Country:US
Practice Address - Phone:559-450-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL9550390200000X
390200000X
CAA197709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA197709OtherTHE MEDICAL BOARD OF CALIFORNIA
CAPTL9550OtherTHE MEDICAL BOARD OF CALIFORNIA