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NPI Code Detail

MEDICARE: MS. SOPHIA S NAKABAYASHI M.A.

MEDICARE: MS. SOPHIA S NAKABAYASHI M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor55964CA

General Provider Information

NPI Number : 1306082995
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SOPHIA S NAKABAYASHI M.A.
Provider Business Mailing Address
First Line : 4160 GRAND VIEW BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-5214
Country : US
Telephone Number : 310-751-1145
Fax Number :
Provider Business Practice Location Address
First Line : 4160 GRAND VIEW BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-5214
Country : US
Telephone Number : 310-751-1145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2009
Last Update Date : 03/30/2011

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