Provider Demographics
NPI:1982311890
Name:OKASAKO, NOEL
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:OKASAKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 W RICHEY AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-9448
Mailing Address - Country:US
Mailing Address - Phone:575-365-6317
Mailing Address - Fax:
Practice Address - Street 1:316 W RUNYAN AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2870
Practice Address - Country:US
Practice Address - Phone:518-260-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
NM1982311890175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist