Provider Demographics
NPI:1992466536
Name:WOLDEMARIAM, YODIT (RN)
Entity type:Individual
Prefix:
First Name:YODIT
Middle Name:
Last Name:WOLDEMARIAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 CASA GRANDE CIR APT 267
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2535
Mailing Address - Country:US
Mailing Address - Phone:951-312-6097
Mailing Address - Fax:
Practice Address - Street 1:4370 CASA GRANDE CIR APT 267
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2535
Practice Address - Country:US
Practice Address - Phone:951-312-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95140800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse