Provider Demographics
NPI:1063702249
Name:YAMAUCHI, MITSUO
Entity type:Individual
Prefix:
First Name:MITSUO
Middle Name:
Last Name:YAMAUCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MITS
Other - Middle Name:
Other - Last Name:YAMAUCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30210 CHERET PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30210 CHERET PL
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-5727
Practice Address - Country:US
Practice Address - Phone:310-634-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 16345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist