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NPI Code Detail

MEDICARE: DR. KOTOMI ITO PH.D.

MEDICARE: DR. KOTOMI ITO PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist32732TX
2103TC0700XClinical PsychologistPSY 20297CA

General Provider Information

NPI Number : 1427127851
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KOTOMI ITO PH.D.
Provider Business Mailing Address
First Line : 310 8TH ST STE 210
Second Line :
City : OAKLAND
State : CA
Zip : 94607-6527
Country : US
Telephone Number : 510-735-3900
Fax Number : 510-474-1715
Provider Business Practice Location Address
First Line : 310 8TH ST STE 210
Second Line :
City : OAKLAND
State : CA
Zip : 94607-6527
Country : US
Telephone Number : 510-735-3900
Fax Number : 510-474-1715
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 04/22/2019

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Directions to “ DR. KOTOMI ITO PH.D.” Practice Location

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