Provider Demographics
NPI:1164582672
Name:NAKAMURA, FRED A (MD)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:A
Last Name:NAKAMURA
Suffix:
Gender:M
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:PO BOX 4008
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740
Mailing Address - Country:US
Mailing Address - Phone:562-985-4771
Mailing Address - Fax:
Practice Address - Street 1:1250 BELLFLOWER BLVD
Practice Address - Street 2:SHS
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90840-0201
Practice Address - Country:US
Practice Address - Phone:562-985-5146
Practice Address - Fax:562-985-8404
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25618208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice