Healthcare Provider Details

I. General information

NPI: 1811816648
Provider Name (Legal Business Name): ILEANA SUGAWARA-KAMEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ILEANA SUGAWARA

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WILLOW PASS RD STE 700
CONCORD CA
94520-7926
US

IV. Provider business mailing address

4159 CALLAN BLVD
DALY CITY CA
94015-4431
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-1474
  • Fax:
Mailing address:
  • Phone: 415-990-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: