Healthcare Provider Details

I. General information

NPI: 1104958321
Provider Name (Legal Business Name): JANICE Y. NAKAGAWA PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 28TH ST SUITE 100
SACRAMENTO CA
95816-6422
US

IV. Provider business mailing address

1409 28TH ST SUITE 100
SACRAMENTO CA
95816-6422
US

V. Phone/Fax

Practice location:
  • Phone: 916-452-3756
  • Fax: 916-452-3757
Mailing address:
  • Phone: 916-452-3756
  • Fax: 916-452-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY7776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: