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General NPI Number Information
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NPI Number | 1144400771
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Entity Type | Individual
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Provider Name | MARY OKIMOTO NP
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Gender | Female
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 892 AEROVISTA PL STE 240
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-8054
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Country | US
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Telephone | 305-395-3277
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD SUITE 400
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City | LOS ANGELES
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State | CA
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Zip | 90095-5631
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Country | US
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Telephone | 310-301-8707
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 567717
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 17444
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License Number State | CA
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