Healthcare Provider Details

I. General information

NPI: 1053843235
Provider Name (Legal Business Name): STERLING NAKAMURA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL DR BLDG 3
MOUNTAIN VIEW CA
94040-4106
US

IV. Provider business mailing address

PO BOX 60579
PALO ALTO CA
94306-0579
US

V. Phone/Fax

Practice location:
  • Phone: 650-962-4928
  • Fax: 650-539-0242
Mailing address:
  • Phone: 650-962-4928
  • Fax: 650-539-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA90609
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number21386
License Number StateCA

VIII. Authorized Official

Name: DR. STERLING NAKAMURA
Title or Position: OWNER
Credential: MD
Phone: 650-962-4928