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General NPI Number Information
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NPI Number | 1700175569
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Entity Type | Individual
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Provider Name | PATRICE MITSURU YASUDA PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 4650 W SUNSET BLVD # 53
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-361-3817
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Fax |
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Provider Business Mailing Address
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Address Line | 4650 SUNSET BLVD, MS #53
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City | LOS ANGELES
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State | CA
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Zip | 90027
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Country | US
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Telephone | 323-361-3817
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY10801
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License Number State | CA
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