Healthcare Provider Details

I. General information

NPI: 1831737329
Provider Name (Legal Business Name): OKAMOTO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2019
Last Update Date: 12/15/2019
Certification Date: 12/15/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4276 SPRING MOUNTAIN RD UNIT 212
LAS VEGAS NV
89102-8781
US

IV. Provider business mailing address

4276 SPRING MOUNTAIN RD UNIT 212
LAS VEGAS NV
89102-8781
US

V. Phone/Fax

Practice location:
  • Phone: 702-802-8567
  • Fax:
Mailing address:
  • Phone: 702-802-8567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL OKAMOTO
Title or Position: OWNER
Credential: MD
Phone: 702-802-8567