Provider Demographics
NPI:1972667905
Name:NAKAMA, GEORGE MASAJI (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MASAJI
Last Name:NAKAMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4453 CABELLO ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3928
Mailing Address - Country:US
Mailing Address - Phone:510-487-5621
Mailing Address - Fax:510-489-0249
Practice Address - Street 1:4453 CABELLO ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3928
Practice Address - Country:US
Practice Address - Phone:510-487-5621
Practice Address - Fax:510-489-0249
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 12779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16325ZMedicare ID - Type UnspecifiedMEDICARE IDENTIFIER