Provider Demographics
NPI:1063446102
Name:OKAMURA, TESSIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:TESSIE
Middle Name:A
Last Name:OKAMURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:1450 TREAT BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2168
Practice Address - Country:US
Practice Address - Phone:925-296-9770
Practice Address - Fax:925-296-9092
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69738208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A697380Medicaid
CAP00055646Medicare PIN
CA00A697380Medicaid
CA00A697381Medicare PIN