Doctor Name: | MR. FRED A NAKAMURA |
NPI Number: | 1164582672 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | G25618 |
Business Practice Address: | 1250 Bellflower Blvd Shs Long Beach, CA - 908400201 |
Business Phone Number: | 5629855146 |
Business Fax Number: | 5629858404 |
Mailing Address: | Po Box 4008, SEAL BEACH |
State: | CA |
Postal Code: | 90740 |
Phone Number: | 5629854771 |
Fax Number: | |
NPI Enumeration Date: | 12/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G25618 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |