Provider Demographics
NPI:1811920077
Name:SALESA, YVONNE
Entity type:Individual
Prefix:MISS
First Name:YVONNE
Middle Name:
Last Name:SALESA
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 1:406 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2802
Mailing Address - Country:US
Mailing Address - Phone:510-663-6440
Mailing Address - Fax:
Practice Address - Street 1:406 15TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2802
Practice Address - Country:US
Practice Address - Phone:510-663-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295800001Medicare NSC