Healthcare Provider Details

I. General information

NPI: 1407380603
Provider Name (Legal Business Name): NAHO HATTORI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST # B100
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

11370 ANDERSON ST # B100
LOMA LINDA CA
92354-3450
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-5929
  • Fax:
Mailing address:
  • Phone: 770-743-8291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1407380603
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA172772
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberM-2372
License Number StateGU
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberM-2372
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: