Provider Demographics
NPI:1417921982
Name:MATAYOSHI, AMY HARUKO (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:HARUKO
Last Name:MATAYOSHI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4225 EXECUTIVE SQ STE 450
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-8411
Mailing Address - Country:US
Mailing Address - Phone:858-810-0000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:3300 VISTA WAY
Practice Address - Street 2:SUITE B
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3752
Practice Address - Country:US
Practice Address - Phone:760-967-9900
Practice Address - Fax:760-967-6769
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-01-25
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Provider Licenses
StateLicense IDTaxonomies
CAA60790207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA60780OtherCA LICENSE
CACA139681OtherNO. CALIFORNIA PTAN
CACB226292OtherSO. CALIFORNIA PTAN