Basic Information
| Provider Information | |||||||||
| NPI: | 1265803217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGASAWA | ||||||||
| FirstName: | HIROMI | ||||||||
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| Credential: | OT, PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 W SAN MARCOS BLVD APT 107 | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920695611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186208085 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3910 VISTA WAY STE 106 | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609412000 | ||||||||
| FaxNumber: | 7609414900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2015 | ||||||||
| LastUpdateDate: | 01/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 294020 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | 15649 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.