Healthcare Provider Details

I. General information

NPI: 1962463497
Provider Name (Legal Business Name): JOYCE YAYOI EZAKI-YAMAGUCHI R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2006
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 E HERNDON AVE STE 201
FRESNO CA
93720-2989
US

IV. Provider business mailing address

1475 W MORRIS AVE
FRESNO CA
93711-2340
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-6600
  • Fax: 559-226-3709
Mailing address:
  • Phone: 559-432-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number332866
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: