Healthcare Provider Details

I. General information

NPI: 1508517517
Provider Name (Legal Business Name): COLLIN YAMAKA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12362 BEACH BLVD STE 10
STANTON CA
90680-3944
US

IV. Provider business mailing address

12362 BEACH BLVD STE 10
STANTON CA
90680-3944
US

V. Phone/Fax

Practice location:
  • Phone: 714-248-9500
  • Fax: 714-622-4943
Mailing address:
  • Phone: 714-248-9500
  • Fax: 714-622-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: