Provider Demographics
NPI:1205418779
Name:SAKAMOTO, NOAH (PMHNP)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:SAKAMOTO
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 IRVINE AVE # 1056
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1048 IRVINE AVE # 1056
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-4602
Practice Address - Country:US
Practice Address - Phone:714-488-9976
Practice Address - Fax:714-495-4105
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760050163WP0808X
CA95018977363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA881425083OtherINTERNAL REVENUE SERVICES