Healthcare Provider Details

I. General information

NPI: 1013525104
Provider Name (Legal Business Name): TOMOAKI NAKAMURA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N BROADWAY STE 101
SANTA ANA CA
92706-2624
US

IV. Provider business mailing address

2100 N BROADWAY STE 101
SANTA ANA CA
92706-2624
US

V. Phone/Fax

Practice location:
  • Phone: 714-245-6881
  • Fax:
Mailing address:
  • Phone: 714-245-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number700211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: