Healthcare Provider Details

I. General information

NPI: 1336073279
Provider Name (Legal Business Name): DIANE N YAMAMOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BEVERLY DR STE 304
BEVERLY HILLS CA
90212-4806
US

IV. Provider business mailing address

300 S BEVERLY DR STE 304
BEVERLY HILLS CA
90212-4806
US

V. Phone/Fax

Practice location:
  • Phone: 310-277-4177
  • Fax:
Mailing address:
  • Phone: 310-277-4177
  • Fax: 310-277-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberRHT5628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: