Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT.0001619 | CO |
Y | 213ES0000X | Sports Medicine | AT.0001619 | CO |
NPI | 1396231387 |
---|---|
Provider Name | Mr. Motoki Kamikura |
First Address | Alamosa, CO 81101-2320 |
Second Address | Alamosa, CO 81101-2320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2018 |
Last Update Date | 03/07/2018 |