Provider Demographics
NPI:1922126259
Name:OKUMOTO, MARIKO
Entity Type:Individual
Prefix:
First Name:MARIKO
Middle Name:
Last Name:OKUMOTO
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 1:18108 S BUDLONG AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3334
Mailing Address - Country:US
Mailing Address - Phone:310-324-6587
Mailing Address - Fax:
Practice Address - Street 1:6055 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2418
Practice Address - Country:US
Practice Address - Phone:323-346-0960
Practice Address - Fax:323-346-0966
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner