MEDICARE: RYAN YAMAMOTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	101337	CA
2	106H00000X	Marriage & Family Therapist	129096	CA

General Provider Information

NPI Number	:	1013422005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN YAMAMOTO

Provider Business Mailing Address
First Line	:	501 N GOLDEN CIRCLE DR STE 100
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N GOLDEN CIRCLE DR STE 100
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3913
Country	:	US
Telephone Number	:	714-543-0483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/13/2022

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Directions to “ RYAN YAMAMOTO ” Practice Location

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