Healthcare Provider Details

I. General information

NPI: 1063720886
Provider Name (Legal Business Name): HEIDI NAKAMURA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W WALNUT PKWY
COMPTON CA
90220-5030
US

IV. Provider business mailing address

1303 W WALNUT PKWY
COMPTON CA
90220-5030
US

V. Phone/Fax

Practice location:
  • Phone: 310-868-5379
  • Fax:
Mailing address:
  • Phone: 310-868-5379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number72879
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number73
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: