Healthcare Provider Details

I. General information

NPI: 1083770440
Provider Name (Legal Business Name): JON MASAO NAKAMOTO M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33608 ORTEGA HWY
SAN JUAN CAPISTRANO CA
92675-2042
US

IV. Provider business mailing address

28562 OSO PKWY # 137
RANCHO SANTA MARGARITA CA
92688-5595
US

V. Phone/Fax

Practice location:
  • Phone: 949-728-4323
  • Fax: 949-728-4960
Mailing address:
  • Phone: 949-709-8299
  • Fax: 949-728-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberG60579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: