Provider Demographics
NPI:1790890564
Name:SHIRATORI, YOSHIYUKI (MS, ATC, CSCS, CKTP)
Entity Type:Individual
Prefix:MR
First Name:YOSHIYUKI
Middle Name:
Last Name:SHIRATORI
Suffix:
Gender:M
Credentials:MS, ATC, CSCS, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5813 ETIWANDA AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2473
Mailing Address - Country:US
Mailing Address - Phone:818-578-3228
Mailing Address - Fax:805-986-5934
Practice Address - Street 1:4000 S ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-6699
Practice Address - Country:US
Practice Address - Phone:805-986-5800
Practice Address - Fax:805-986-5934
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer