MEDICARE: DR. MASON MASAKI YAMASHITA MD

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	2084P0800X	Psychiatry Physician	A76245	CA

General Provider Information

NPI Number	:	1982713517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASON MASAKI YAMASHITA MD

Provider Business Mailing Address
First Line	:	12790 EL CAMINO REAL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2007
Country	:	US
Telephone Number	:	858-617-7523
Fax Number	:	858-617-7705

Provider Business Practice Location Address
First Line	:	3626 TORREY VIEW CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2620
Country	:	US
Telephone Number	:	619-306-2125
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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