Healthcare Provider Details

I. General information

NPI: 1144512443
Provider Name (Legal Business Name): NAOMI AISO NAGASAWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

6 WINDSOR
NEWPORT BEACH CA
92660-6735
US

IV. Provider business mailing address

6 WINDSOR
NEWPORT BEACH CA
92660-6735
US

V. Phone/Fax

Practice location:
  • Phone: 949-759-6914
  • Fax:
Mailing address:
  • Phone: 949-759-6914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG080171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: