Provider Demographics
NPI:1427538941
Name:OYAMA, GARRETT R (MS CCC, SLP)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:R
Last Name:OYAMA
Suffix:
Gender:M
Credentials:MS CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 TIBURON CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3436
Mailing Address - Country:US
Mailing Address - Phone:192-576-8637
Mailing Address - Fax:
Practice Address - Street 1:195 GLEN COVE MARINA RD E # 202
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7285
Practice Address - Country:US
Practice Address - Phone:707-651-9915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist