Healthcare Provider Details

I. General information

NPI: 1871910265
Provider Name (Legal Business Name): CLAUDINE YAMAOKA PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17742 BEACH BLVD #240
HUNTINGTON BEACH CA
92647-6818
US

IV. Provider business mailing address

17742 BEACH BLVD #240
HUNTINGTON BEACH CA
92647-6818
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-0444
  • Fax: 714-842-8444
Mailing address:
  • Phone: 714-842-0444
  • Fax: 714-842-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number293023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: