Provider Demographics
NPI:1750393617
Name:NAKAGUCHI, PETER MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:NAKAGUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 VALLEY CHILDRENS PL
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-6425
Mailing Address - Fax:559-353-6441
Practice Address - Street 1:9300 VALLEY CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-8761
Practice Address - Country:US
Practice Address - Phone:559-353-6425
Practice Address - Fax:559-353-6441
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA161636OtherCMS
CA00G781620Medicaid
CA161636OtherCMS
CA00G781620Medicare PIN