Provider Demographics
NPI:1609235860
Name:NAKAWATASE, HAYATO
Entity Type:Individual
Prefix:MR
First Name:HAYATO
Middle Name:
Last Name:NAKAWATASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N BROOKHURST ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5226
Mailing Address - Country:US
Mailing Address - Phone:657-272-0725
Mailing Address - Fax:
Practice Address - Street 1:501 N BROOKHURST ST
Practice Address - Street 2:SUITE 306
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5226
Practice Address - Country:US
Practice Address - Phone:657-272-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health