MEDICARE: MRS. KRISTINA ROSE YAMAGUCHI

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1245983139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINA ROSE YAMAGUCHI

Provider Business Mailing Address
First Line	:	1105 COLORADO AVE # A
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-3522
Country	:	US
Telephone Number	:	970-644-1112
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 COLORADO AVE # A
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-3522
Country	:	US
Telephone Number	:	970-644-1112
Fax Number	:

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

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	01/31/2022

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