Provider Demographics
NPI:1154530236
Name:CAZORLA-LANCASTER, YAMILETH R (DO)
Entity type:Individual
Prefix:
First Name:YAMILETH
Middle Name:R
Last Name:CAZORLA-LANCASTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20968
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4106
Mailing Address - Country:US
Mailing Address - Phone:509-494-6700
Mailing Address - Fax:888-565-2493
Practice Address - Street 1:3105 SUMMITVIEW AVE STE C
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2310
Practice Address - Country:US
Practice Address - Phone:509-969-6214
Practice Address - Fax:888-565-2493
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58002134390200000X
WAOP60077117208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0254646OtherLABOR & INDUSTRIES
WA8543951Medicaid
WAAB38059Medicare Oscar/Certification
WA0254646OtherLABOR & INDUSTRIES