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General NPI Number Information
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NPI Number | 1063323095
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Entity Type | Individual
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Provider Name | SAKURA TANAKA
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Gender | Female
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 620 OLIVE AVE
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City | LONG BEACH
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State | CA
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Zip | 90802-1546
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Country | US
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Telephone | 562-435-4496
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Fax |
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Provider Business Mailing Address
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Address Line | 11002 AUGUSTA WAY
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City | STANTON
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State | CA
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Zip | 90680-2809
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Country | US
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Telephone | 657-257-8075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | CA
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