Healthcare Provider Details

I. General information

NPI: 1295746485
Provider Name (Legal Business Name): KEITH JAY OYAMA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 ORANGE ST
RIVERSIDE CA
92501-2538
US

IV. Provider business mailing address

1420 RIVERA ST
RIVERSIDE CA
92501-1507
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-9515
  • Fax:
Mailing address:
  • Phone: 909-583-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH-1659
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: