1659468189 NPI number — DR. HARUKO TARA YAWATA D.O.

Table of content: DR. HARUKO TARA YAWATA D.O. (NPI 1659468189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659468189 NPI number — DR. HARUKO TARA YAWATA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAWATA
Provider First Name:
HARUKO
Provider Middle Name:
TARA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659468189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5504 SCOTWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO PALOS VERDES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90275-4913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-541-2683
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3640 LOMITA BLVD
Provider Second Line Business Practice Location Address:
309
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-3927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-465-1604
Provider Business Practice Location Address Fax Number:
310-465-1607
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20A7128 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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