Healthcare Provider Details

I. General information

NPI: 1588839146
Provider Name (Legal Business Name): SATOKO MIYAMOTO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BROADWAY STE 300
OAKLAND CA
94612-1809
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 510-834-2049
  • Fax: 510-834-2045
Mailing address:
  • Phone: 916-576-7900
  • Fax: 916-285-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A8319
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A8319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: