Provider Demographics
NPI:1306061098
Name:YAMAMURA, LORRAINE M (PHD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:M
Last Name:YAMAMURA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 SAWTELLE BLVD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7006
Mailing Address - Country:US
Mailing Address - Phone:310-478-2903
Mailing Address - Fax:
Practice Address - Street 1:1849 SAWTELLE BLVD
Practice Address - Street 2:SUITE 503
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7006
Practice Address - Country:US
Practice Address - Phone:310-478-2903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA142813OtherVALUE OPTIONS
CAOPL110670OtherBLUE SHIELD