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General NPI Number Information
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NPI Number | 1639793110
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Entity Type | Individual
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Provider Name | GRACE HARUMI NAKAMURA PA
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Gender | Female
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Dates
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Enumeration Date | 06/01/2020
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 17271 BROOKHURST ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3701
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Country | US
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Telephone | 714-531-2966
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Fax | 714-531-3495
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Provider Business Mailing Address
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Address Line | 4000 HOLLYWOOD BLVD STE 215S
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City | HOLLYWOOD
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State | FL
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Zip | 33021-1227
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Country | US
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Telephone | 202-963-6487
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Fax | 206-309-8389
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 60016
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License Number State | CA
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