Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | G67564 | CA |
NPI | 1013930908 |
---|---|
Provider Name | Dr. Glenn Ernest Nakamura |
First Address | Newport Beach, CA 92658-0429 |
Second Address | Long Beach, CA 90806-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G657640 | (05) | CA |
00G657640 | BLUE SHIELD ID # (01) | CA |
00G657640385 | CALOPTIMA ID # (01) | CA |
F28823 | (02) | CA |