Basic Information
| Provider Information | |||||||||
| NPI: | 1316521768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAMADA | ||||||||
| FirstName: | RACHEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3833 HURON AVE APT 1 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902323871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108470238 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 AVIATION BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | REDONDO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902784059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103762468 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2021 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 100073 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.