Healthcare Provider Details

I. General information

NPI: 1316239403
Provider Name (Legal Business Name): AYAKO TOKUDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S MYRTLE AVE
MONROVIA CA
91016-3427
US

IV. Provider business mailing address

1703 MOUNTAIN TERRACE LN
MONTEBELLO CA
90640-2046
US

V. Phone/Fax

Practice location:
  • Phone: 626-357-3258
  • Fax:
Mailing address:
  • Phone: 626-233-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: