Provider Demographics
NPI:1023127156
Name:ELENA YAMAGUCHI MD PA
Entity type:Organization
Organization Name:ELENA YAMAGUCHI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMAGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-495-9289
Mailing Address - Street 1:13550 JOG RD
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259993700Medicaid
FLK5289OtherMEDICARE GROUP PIN
FLNI446OtherWELLCARE
FL440002986OtherRAILROAD MEDICARE
FL27681OtherBLUE CROSS BLUE SHIELD OF FLA
FLNI446OtherWELLCARE