Healthcare Provider Details

I. General information

NPI: 1225320286
Provider Name (Legal Business Name): ATSIE ANTONIA YASUTAKE M.A., P.P.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 EAST ARROW HWY
POMONA CA
91767
US

IV. Provider business mailing address

831 E ARROW HWY
POMONA CA
91767-2535
US

V. Phone/Fax

Practice location:
  • Phone: 909-398-4383
  • Fax: 909-398-0127
Mailing address:
  • Phone: 909-398-4383
  • Fax: 909-398-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number59795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: