Provider Demographics
NPI:1235145178
Name:NAKAMURA, AKIRA BOB (MSW)
Entity type:Individual
Prefix:MR
First Name:AKIRA
Middle Name:BOB
Last Name:NAKAMURA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-0447
Mailing Address - Country:US
Mailing Address - Phone:562-596-7952
Mailing Address - Fax:562-598-5359
Practice Address - Street 1:910 MAR VISTA AVENUE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5840
Practice Address - Country:US
Practice Address - Phone:562-596-7952
Practice Address - Fax:562-598-5359
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS105011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS10501OtherBBSE