Provider Demographics
NPI:1528600673
Name:YAMAMOTO, MARIKO (LAC)
Entity Type:Individual
Prefix:
First Name:MARIKO
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 5TH AVE APT 50F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-5953
Mailing Address - Country:US
Mailing Address - Phone:646-419-0349
Mailing Address - Fax:
Practice Address - Street 1:241 W 37TH ST RM 407
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6887
Practice Address - Country:US
Practice Address - Phone:646-419-0349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006543171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist