Provider Demographics
NPI:1013543727
Name:NAKAMA, TRENTON (DPT)
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:
Last Name:NAKAMA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5248
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5248
Mailing Address - Country:US
Mailing Address - Phone:657-224-9490
Mailing Address - Fax:
Practice Address - Street 1:1224 E GREEN ST FL 2
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3169
Practice Address - Country:US
Practice Address - Phone:626-356-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist