Healthcare Provider Details

I. General information

NPI: 1043207459
Provider Name (Legal Business Name): RYAN HISASHI NAKASONE D.C., P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PASEO CAMARILLO
CAMARILLO CA
93010-6073
US

IV. Provider business mailing address

1100 PASEO CAMARILLO
CAMARILLO CA
93010-6073
US

V. Phone/Fax

Practice location:
  • Phone: 805-895-5984
  • Fax:
Mailing address:
  • Phone: 805-895-5984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-24909
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: