Most Relevant Information
Provider Data
| NPI Number: | 1003483066 |
| Provider Name: | ERIC MASAYOSHI IMOTO |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/08/2021 |
| Last Updated: | 06/08/2021 |
Provider Practice Location
401 S TUSTIN ST BLDG C
ORANGE
CA
928662550
Practice Location Phone/Fax
| Phone: | 7143614860 |
| Fax: |
Provider Mailing Location
401 S TUSTIN ST BLDG C
ORANGE
CA
928662550
Provider Mailing Phone/Fax
| Phone: | 7143614860 |
| Fax: |