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Individual

MARIKO ISHIYAMA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.O

Contact information

Practice address
1441 FLORIDA AVE, MODESTO, CA 95350-4404
(209) 576-3525
Mailing address
3606 BROOK ST, LAFAYETTE, CA 94549-4202
(510) 703-9040

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
20A13309
CA
208M00000X
Hospitalist Physician
Primary
12904
CA

Other

Enumeration date
06/06/2012
Last updated
08/14/2024
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