Basic Information
| Provider Information | |||||||||
| NPI: | 1205918778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YAMAMOTO SKOWRON | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD, CCH, CH, CI | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | YAMAMOTO SKOWRON OUADFEL | ||||||||
| OtherFirstName: | DIANE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CCH, RSHOM, CI, CH, | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1505 N EDGEMONT ST | ||||||||
| Address2: | PHARMACY | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900275209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237834148 | ||||||||
| FaxNumber: | 3237835694 | ||||||||
| Practice Location | |||||||||
| Address1: | 6255 W SUNSET BLVD FL 21 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900287422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238605200 | ||||||||
| FaxNumber: | 3237228040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175L00000X | CA | N | Other Service Providers | Homeopath | 1835N1003X | 43278 | CA | N | Pharmacy Service Providers | Pharmacist | Nutrition Support | 1835P1200X | 43278 | CA | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.