Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A16275 | CA |
NPI | 1235341777 |
---|---|
Provider Name | Doe Yamashiro |
First Address | Santa Monica, CA 90405 |
Second Address | Santa Monica, CA 90405-1718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 31/12/2018 |