Provider Demographics
NPI:1033220009
Name:NAKANO, MASAAKI (DOM LAC)
Entity Type:Individual
Prefix:MR
First Name:MASAAKI
Middle Name:
Last Name:NAKANO
Suffix:
Gender:M
Credentials:DOM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 S TELSHOR BLVD
Mailing Address - Street 2:SUITE 202F
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:505-647-0406
Mailing Address - Fax:505-523-8510
Practice Address - Street 1:755 S TELSHOR BLVD
Practice Address - Street 2:SUITE 202F
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:505-647-0406
Practice Address - Fax:505-523-8510
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM247171100000X
TXAC00282171100000X
HIACU559171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist