Provider Demographics
NPI:1841807195
Name:NAKAMOTO, ANGELA GAYLE
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:GAYLE
Last Name:NAKAMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S RAINBOW BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5343
Mailing Address - Country:US
Mailing Address - Phone:702-912-5404
Mailing Address - Fax:
Practice Address - Street 1:222 S RAINBOW BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5343
Practice Address - Country:US
Practice Address - Phone:702-412-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner