Healthcare Provider Details

I. General information

NPI: 1316507486
Provider Name (Legal Business Name): MELISSA BELLE OKIMURA BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

IV. Provider business mailing address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-2931
  • Fax:
Mailing address:
  • Phone: 213-381-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: