Provider Demographics
NPI:1770562498
Name:NAKATA, NAOMI (MA)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:NAKATA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 AVENIDA DE CAMELIA
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6392
Mailing Address - Country:US
Mailing Address - Phone:310-544-4408
Mailing Address - Fax:310-544-4878
Practice Address - Street 1:5300 MCCONNELL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7026
Practice Address - Country:US
Practice Address - Phone:310-482-5561
Practice Address - Fax:310-482-5600
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC310OtherABGC CERTIFICATE NUMBER
CA1785OtherABMG CERTIFICATE NUMBER