Provider Demographics
NPI:1114547916
Name:YONEYAMA, RAISA MIA UNTALAN PANGILINAN (RPH)
Entity Type:Individual
Prefix:
First Name:RAISA MIA
Middle Name:UNTALAN PANGILINAN
Last Name:YONEYAMA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:RAISA MIA
Other - Middle Name:UNTALAN
Other - Last Name:PANGILINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:800 N LOVERS LN APT 202
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-7407
Mailing Address - Country:US
Mailing Address - Phone:510-386-8108
Mailing Address - Fax:
Practice Address - Street 1:317 E KINGS ST
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-1630
Practice Address - Country:US
Practice Address - Phone:559-345-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist