Healthcare Provider Details

I. General information

NPI: 1790890564
Provider Name (Legal Business Name): YOSHIYUKI SHIRATORI MS, ATC, CSCS, CKTP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 S ROSE AVE
OXNARD CA
93033-6699
US

IV. Provider business mailing address

5813 ETIWANDA AVE
TARZANA CA
91356-2473
US

V. Phone/Fax

Practice location:
  • Phone: 805-986-5800
  • Fax: 805-986-5934
Mailing address:
  • Phone: 818-578-3228
  • Fax: 805-986-5934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: