Provider Demographics
NPI:1205471240
Name:NAKAMOTO, BREENA
Entity type:Individual
Prefix:
First Name:BREENA
Middle Name:
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 1:1766 N CEDAR GLEN DR APT A
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1334
Mailing Address - Country:US
Mailing Address - Phone:714-865-6095
Mailing Address - Fax:
Practice Address - Street 1:9645 ARROW ROUTE
Practice Address - Street 2:BUILDING 5, SUITE A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-948-5747
Practice Address - Fax:909-948-5746
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker