Healthcare Provider Details

I. General information

NPI: 1528371259
Provider Name (Legal Business Name): YASHASWINI YERAGUNTA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 LOMITA BLVD STE 235
TORRANCE CA
90505-5111
US

IV. Provider business mailing address

2841 LOMITA BLVD STE 235
TORRANCE CA
90505-5111
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-9110
  • Fax:
Mailing address:
  • Phone: 310-325-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberWA60720560
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD60720560
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2010020476
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA130113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: