=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053843235
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STERLING NAKAMURA MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2017
-----------------------------------------------------
Last Update Date | 03/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 HOSPITAL DR BLDG 3
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-4106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-962-4928
-----------------------------------------------------
Fax | 650-539-0242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 60579
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94306-0579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-962-4928
-----------------------------------------------------
Fax | 650-539-0242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STERLING NAKAMURA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 650-962-4928
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 21386
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A90609
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------