Provider Demographics
NPI:1962463497
Name:EZAKI-YAMAGUCHI, JOYCE YAYOI (RD)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:YAYOI
Last Name:EZAKI-YAMAGUCHI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 W MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2340
Mailing Address - Country:US
Mailing Address - Phone:559-432-1414
Mailing Address - Fax:
Practice Address - Street 1:568 E HERNDON AVE STE 201
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2989
Practice Address - Country:US
Practice Address - Phone:559-228-6600
Practice Address - Fax:559-226-3709
Is Sole Proprietor?:No
Enumeration Date:2006-04-02
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332866133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01738Z#Q48776Medicare UPIN