Provider Demographics
NPI:1104816230
Name:TSUTSUMI, ROGER YORIKI (DPM)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:YORIKI
Last Name:TSUTSUMI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 MAGNOLIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3842
Mailing Address - Country:US
Mailing Address - Phone:951-359-8800
Mailing Address - Fax:951-359-8802
Practice Address - Street 1:7111 MAGNOLIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3842
Practice Address - Country:US
Practice Address - Phone:951-359-8802
Practice Address - Fax:951-359-8802
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4188213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41880Medicare ID - Type Unspecified
CAU83391Medicare UPIN