Provider Demographics
NPI:1609980531
Name:YAMAGUCHI, ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:YAMAGUCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13550 JOG RD
Mailing Address - Street 2:202A
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3808
Mailing Address - Country:US
Mailing Address - Phone:561-495-9289
Mailing Address - Fax:561-495-9293
Practice Address - Street 1:13550 JOG RD
Practice Address - Street 2:202A
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3808
Practice Address - Country:US
Practice Address - Phone:561-495-9289
Practice Address - Fax:561-495-9293
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044985207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL440002986OtherRAILROAD MEDICARE
FL259993700Medicaid
FLNI446OtherWELLCARE
FL27681OtherBLUE CROSS BLUE SHIELD OF FLA
FL27681XMedicare PIN
FL440002986OtherRAILROAD MEDICARE
FL259993700Medicaid