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General NPI Number Information
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NPI Number | 1245617075
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Entity Type | Individual
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Provider Name | MARI YASUNAGA MD
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Gender | Female
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 11234 ANDERSON STREET EMERGENCY MEDICINE RESIDENCY TRAINING PROGRAM
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City | LOMA LINDA
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State | CA
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Zip | 92354
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Country | US
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Telephone | 909-558-4085
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Fax |
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Provider Business Mailing Address
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Address Line | 13737 NOEL RD STE 1600
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City | DALLAS
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State | TX
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Zip | 75240-1374
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Country | US
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Telephone |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A144693
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | R6509
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License Number State | TX
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