Provider Demographics
NPI:1871773838
Name:R SCOTT NANAMURA AC INC
Entity type:Organization
Organization Name:R SCOTT NANAMURA AC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:NANAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:530-541-6392
Mailing Address - Street 1:PO BOX 9579
Mailing Address - Street 2:
Mailing Address - City:S LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-2579
Mailing Address - Country:US
Mailing Address - Phone:530-541-6392
Mailing Address - Fax:
Practice Address - Street 1:2489 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE 28
Practice Address - City:S LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7728
Practice Address - Country:US
Practice Address - Phone:530-541-6292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5974171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 5974OtherCALIFORNIA LAC LICENSE