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NPI Code Detail

MEDICARE: MR. PHILLIP YASUO YOSHIMURA I PA-C

MEDICARE: MR. PHILLIP YASUO YOSHIMURA I PA-C
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
1363A00000XPhysician AssistantPA 10223CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831252832
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHILLIP YASUO YOSHIMURA I PA-C
Provider Business Mailing Address
First Line : 1111 N EL DORADO ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number : 209-938-0228
Fax Number :
Provider Business Practice Location Address
First Line : 1111 N EL DORADO ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number : 209-938-0228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 07/09/2007

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