Healthcare Provider Details

I. General information

NPI: 1457387417
Provider Name (Legal Business Name): ALFRED MITSURU YAMAMOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SOUTH ST PATHOLOGY DEPT
LAKEWOOD CA
90712-1419
US

IV. Provider business mailing address

2374 E PACIFICA PL
RANCHO DOMINGUEZ CA
90220-6214
US

V. Phone/Fax

Practice location:
  • Phone: 562-602-6737
  • Fax: 562-602-6896
Mailing address:
  • Phone: 310-225-3244
  • Fax: 310-698-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG61896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: