Healthcare Provider Details

I. General information

NPI: 1063696367
Provider Name (Legal Business Name): DENNIS YASUDA MARSHALL RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY SUITE 500
BOCA RATON FL
33487-2773
US

IV. Provider business mailing address

73-4326 AKA AKA PLACE
KAILUA-KONA HI
96740-9507
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-0884
  • Fax:
Mailing address:
  • Phone: 808-938-1052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberL04915
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number5679
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: