Basic Information
| Provider Information | |||||||||
| NPI: | 1548481088 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YOSHIOKA | ||||||||
| FirstName: | JIM | ||||||||
| MiddleName: | MASAO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4325 BERRYMAN AVENUE | ||||||||
| Address2: | APT 8 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900666050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109151626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4655 RUFFNER STREET | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007876787 | ||||||||
| FaxNumber: | 8007876762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA1195 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.