Healthcare Provider Details

I. General information

NPI: 1164059747
Provider Name (Legal Business Name): MICHAEL ALEXANDER OKAZAKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MONTE VISTA AVE STE 100
CLAREMONT CA
91711-6601
US

IV. Provider business mailing address

1601 MONTE VISTA AVE STE 260
CLAREMONT CA
91711-6604
US

V. Phone/Fax

Practice location:
  • Phone: 909-630-7938
  • Fax: 909-469-1469
Mailing address:
  • Phone: 909-865-9501
  • Fax: 909-469-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A19850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: