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General NPI Number Information
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NPI Number | 1164774774
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Entity Type | Individual
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Provider Name | STACEY HALLARCES NAKAYAMA DPT
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Gender | Female
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 121 E 18TH ST
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City | COSTA MESA
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State | CA
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Zip | 92627-3034
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Country | US
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Telephone | 213-792-2616
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 RALEIGH AVE
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City | COSTA MESA
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State | CA
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Zip | 92627-2909
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Country | US
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Telephone | 408-781-2511
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 39125
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License Number State | CA
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