Healthcare Provider Details

I. General information

NPI: 1245926849
Provider Name (Legal Business Name): ALAN TOMONARI AKITA DNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S G ST
SAN BERNARDINO CA
92410-3320
US

IV. Provider business mailing address

15599 ALLSPICE LN
FONTANA CA
92336-3587
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-7100
  • Fax:
Mailing address:
  • Phone: 909-561-4922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030863
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95157313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: