Healthcare Provider Details

I. General information

NPI: 1760300503
Provider Name (Legal Business Name): MICHAEL YONAMINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 7TH ST
SAN PEDRO CA
90732-3505
US

IV. Provider business mailing address

1300 W 7TH ST
SAN PEDRO CA
90732-3505
US

V. Phone/Fax

Practice location:
  • Phone: 310-241-4335
  • Fax:
Mailing address:
  • Phone: 310-241-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95222378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: