Healthcare Provider Details

I. General information

NPI: 1265803217
Provider Name (Legal Business Name): HIROMI NAGASAWA OT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 VISTA WAY STE 106
OCEANSIDE CA
92056-4513
US

IV. Provider business mailing address

353 W SAN MARCOS BLVD APT 107
SAN MARCOS CA
92069-5611
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-2000
  • Fax: 760-941-4900
Mailing address:
  • Phone: 818-620-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number294020
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: