Healthcare Provider Details

I. General information

NPI: 1508082645
Provider Name (Legal Business Name): NANCY ITSUYO OKAMOTO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ITSUYO NANCY OKAMOTO NP

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PHELAN AVE HEALTH CENTER 100
SAN FRANCISCO CA
94112-1821
US

IV. Provider business mailing address

1432 HUBBARD AVE
SAN LEANDRO CA
94579-1316
US

V. Phone/Fax

Practice location:
  • Phone: 415-239-3192
  • Fax: 415-239-3193
Mailing address:
  • Phone: 510-352-6586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number191280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: