Healthcare Provider Details

I. General information

NPI: 1770562498
Provider Name (Legal Business Name): NAOMI NAKATA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MCCONNELL AVE
LOS ANGELES CA
90066-7026
US

IV. Provider business mailing address

20 AVENIDA DE CAMELIA
RANCHO PALOS VERDES CA
90275-6392
US

V. Phone/Fax

Practice location:
  • Phone: 310-482-5561
  • Fax: 310-482-5600
Mailing address:
  • Phone: 310-544-4408
  • Fax: 310-544-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: