Provider Demographics
NPI:1265803217
Name:NAGASAWA, HIROMI (OT, PT)
Entity type:Individual
Prefix:
First Name:HIROMI
Middle Name:
Last Name:NAGASAWA
Suffix:
Gender:F
Credentials:OT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 W SAN MARCOS BLVD APT 107
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-5611
Mailing Address - Country:US
Mailing Address - Phone:818-620-8085
Mailing Address - Fax:
Practice Address - Street 1:3910 VISTA WAY STE 106
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4513
Practice Address - Country:US
Practice Address - Phone:760-941-2000
Practice Address - Fax:760-941-4900
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294020225100000X
CA15649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist