MEDICARE: FATIMA ICHINOKUCHI PH D

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
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1679827265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATIMA ICHINOKUCHI PH D

Provider Business Mailing Address
First Line	:	2007 DEL HOLLOW ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2841
Country	:	US
Telephone Number	:	562-602-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 DEL HOLLOW ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2841
Country	:	US
Telephone Number	:	562-602-2900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2012
Last Update Date	:	11/03/2012

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