Healthcare Provider Details

I. General information

NPI: 1295862092
Provider Name (Legal Business Name): RUMIKO OKADA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 E FRUIT ST SUITE 109
SANTA ANA CA
92701-4459
US

IV. Provider business mailing address

2220 E FRUIT ST SUITE 109
SANTA ANA CA
92701-4459
US

V. Phone/Fax

Practice location:
  • Phone: 714-541-8255
  • Fax: 714-541-8256
Mailing address:
  • Phone: 714-541-8255
  • Fax: 714-541-8256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: