Provider Demographics
NPI:1619065414
Name:AKINAKA, BRUCE K (PT, ATC, HEALTH CERT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:K
Last Name:AKINAKA
Suffix:
Gender:M
Credentials:PT, ATC, HEALTH CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3038 CAYENTE WAY
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8879
Mailing Address - Country:US
Mailing Address - Phone:530-677-0406
Mailing Address - Fax:
Practice Address - Street 1:3105 CEDAR RAVINE RD STE 201
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6561
Practice Address - Country:US
Practice Address - Phone:530-626-2770
Practice Address - Fax:530-622-7143
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10876174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT10876OtherSTATE LICENSE