Healthcare Provider Details

I. General information

NPI: 1306507413
Provider Name (Legal Business Name): RYAN HITOSHI TAMURA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST
SAN FRANCISCO CA
94158-2334
US

IV. Provider business mailing address

2950 GRAYMONT CT
CONCORD CA
94518-2832
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7598
  • Fax:
Mailing address:
  • Phone: 925-890-7926
  • Fax:

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: