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General NPI Number Information
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NPI Number | 1154654952
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Entity Type | Individual
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Provider Name | RUBY GUZMAN YAMAMOTO PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 5086 N ELSTON AVE
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City | CHICAGO
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State | IL
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Zip | 60630-2427
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Country | US
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Telephone | 773-725-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 5415 N SHERIDAN RD APT 911
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City | CHICAGO
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State | IL
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Zip | 60640-1969
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Country | US
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Telephone | 708-408-1324
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085.003541
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License Number State | IL
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