Healthcare Provider Details

I. General information

NPI: 1477824027
Provider Name (Legal Business Name): ELISE H OKAMOTO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 12/13/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25965 NORMANDIE AVE
HARBOR CITY CA
90710-3416
US

IV. Provider business mailing address

25965 NORMANDIE AVE
HARBOR CITY CA
90710-3416
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number22049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: