Provider Demographics
NPI:1083913180
Name:NAKAGAWA, JENNA NAGATA (PA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NAGATA
Last Name:NAKAGAWA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 FENN ST.
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614
Mailing Address - Country:US
Mailing Address - Phone:626-278-2351
Mailing Address - Fax:
Practice Address - Street 1:300 CORPORATE POINTE STE 465
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-8706
Practice Address - Country:US
Practice Address - Phone:323-203-0070
Practice Address - Fax:310-561-1902
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant