Patient | Yvette Etteldorf | Preferred Language | Unspecified |
Date of birth | November 11, 1979 | Sex | Female |
Race | Unspecified
|
Ethnicity | Unspecified |
Contact info | Home:
5815 Harkins Ave Little Rock, AR 72210, US Tel (Mobile): +1(501)-347-4464 Tel (Primary Home): +1(501)-347-4464 Mail: yetteldorf@gmail.com |
Patient IDs | 3358126 2.16.840.1.113883.3.3710.999.44.88800115636.7770000101
MM0000001192 2.16.840.1.113883.3.3710.3 MODMED 2.16.840.1.113883.3.3710.200.501 115636PAT000001202 2.16.840.1.113883.3.3710.200.500 |
Document Id | test-id-707227053 2.16.840.1.113883.3.3710.0 |
Document Created: | April 6, 2024, 17:33:19 +0000 |
Author | Diana Tagaban, Jaime S. Schwartz, MD |
Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |
Encounter Id | |||
Encounter Date | From , to , | ||
Encounter Participant | |||
Contact info |
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Legal authenticator | Diana Tagaban signed at April 6, 2024, 17:33:19 +0000 |
Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |
Document maintained by | Jaime S. Schwartz, MD |
Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |