Healthcare Provider Details

I. General information

NPI: 1568163103
Provider Name (Legal Business Name): MS. MARIKO KATHRYN OKAMOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 ARROYO CIR STE B
GILROY CA
95020-7346
US

IV. Provider business mailing address

50 MCGINNIS RD
ROYAL OAKS CA
95076-5709
US

V. Phone/Fax

Practice location:
  • Phone: 877-910-6538
  • Fax:
Mailing address:
  • Phone: 831-346-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: