Provider Demographics
NPI:1821024852
Name:YAMAGATA, NELSON T (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:T
Last Name:YAMAGATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 POSADA LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4057
Mailing Address - Country:US
Mailing Address - Phone:805-434-0335
Mailing Address - Fax:805-434-0421
Practice Address - Street 1:225 POSADA LN
Practice Address - Street 2:SUITE E
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4058
Practice Address - Country:US
Practice Address - Phone:805-434-0335
Practice Address - Fax:805-434-0421
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG670762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF67393Medicare UPIN
G67076Medicare ID - Type Unspecified