Provider Demographics
NPI:1831930239
Name:YA, MARC SU (FNP-C)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:SU
Last Name:YA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 EXPLORER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2728
Mailing Address - Country:US
Mailing Address - Phone:916-642-1867
Mailing Address - Fax:
Practice Address - Street 1:3030 EXPLORER DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2728
Practice Address - Country:US
Practice Address - Phone:209-313-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health