Healthcare Provider Details

I. General information

NPI: 1528481421
Provider Name (Legal Business Name): ERIKO NAKAJIMA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE SUITE 309
DOWNEY CA
90241-5018
US

IV. Provider business mailing address

410 CANYON VISTA DR
LOS ANGELES CA
90065-3965
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-1201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number51337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: