Provider Demographics
NPI:1376637801
Name:NAKASHIMA, GEORGE ETSURO (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ETSURO
Last Name:NAKASHIMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 E 3RD STREET
Mailing Address - Street 2:SUITE 803
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1646
Mailing Address - Country:US
Mailing Address - Phone:213-617-7073
Mailing Address - Fax:213-617-3132
Practice Address - Street 1:420 E 3RD STREET
Practice Address - Street 2:SUITE 803
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1646
Practice Address - Country:US
Practice Address - Phone:213-617-7073
Practice Address - Fax:213-617-3132
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG413902080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine