Basic Information
| Provider Information | |||||||||
| NPI: | 1689687428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAMAGUCHI | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 S RANGERVILLE RD | ||||||||
| Address2: | BLDG. 503 | ||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785527638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563648400 | ||||||||
| FaxNumber: | 9563648497 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 S RANGERVILLE RD | ||||||||
| Address2: | BLDG. 503 | ||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785527638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563648400 | ||||||||
| FaxNumber: | 9563648497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G5858 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | F0084370 | 01 | TX | CONTROLLED SUBSTANCE | OTHER |