Basic Information
| Provider Information | |||||||||
| NPI: | 1447231873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGUWA | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | MASAJI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 451 EAST HEALTH SCIENCES DRIVE | ||||||||
| Address2: | GBSF, UNIVERSITY OF CALIFORNIA | ||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307522884 | ||||||||
| FaxNumber: | 5307546047 | ||||||||
| Practice Location | |||||||||
| Address1: | 2660 W COVELL BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956165645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307473074 | ||||||||
| FaxNumber: | 5307928556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2005 | ||||||||
| LastUpdateDate: | 08/30/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | G33104 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 00G331040 | 05 | CA | MEDICAID |