Healthcare Provider Details

I. General information

NPI: 1891685301
Provider Name (Legal Business Name): CODY YAMAGUCHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 RIVER PARK PL W
FRESNO CA
93720
US

IV. Provider business mailing address

8680 N GLENN AVE APT 265
FRESNO CA
93711-6947
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-4950
  • Fax:
Mailing address:
  • Phone: 808-352-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95310485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: