Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 9572 | NV |
NPI | 1295721918 |
---|---|
Provider Name | Mr. Craig Tadashi Nakamura |
First Address | Las Vegas, NV 89109-6205 |
Second Address | Las Vegas, NV 89109-6205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 16/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002018611 | (05) | NV |
H32485 | (02) |