Provider Demographics
NPI:1992569883
Name:YAMAMOTO, MEGAN EMILY
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:EMILY
Last Name:YAMAMOTO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 E SAINT JAMES CIR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1417
Mailing Address - Country:US
Mailing Address - Phone:559-930-5025
Mailing Address - Fax:
Practice Address - Street 1:2300 BOSWELL RD STE 280
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3539
Practice Address - Country:US
Practice Address - Phone:559-930-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65270363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant