Provider Demographics
NPI:1285673202
Name:YAMARIK, REBECCA LIDDICOAT (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LIDDICOAT
Last Name:YAMARIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261A PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-1753
Mailing Address - Country:US
Mailing Address - Phone:562-298-0030
Mailing Address - Fax:
Practice Address - Street 1:261A PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-1753
Practice Address - Country:US
Practice Address - Phone:562-298-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH85100Medicare UPIN
CAWA92299AMedicare PIN
CAWA92299BMedicare PIN