Provider Demographics
NPI:1659468189
Name:YAWATA, HARUKO TARA (DO)
Entity Type:Individual
Prefix:DR
First Name:HARUKO
Middle Name:TARA
Last Name:YAWATA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5504 SCOTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-4913
Mailing Address - Country:US
Mailing Address - Phone:310-541-2683
Mailing Address - Fax:
Practice Address - Street 1:3640 LOMITA BLVD
Practice Address - Street 2:309
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3927
Practice Address - Country:US
Practice Address - Phone:310-465-1604
Practice Address - Fax:310-465-1607
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2021-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH29571Medicare UPIN