1487647335 NPI number — LLOYD STUART NAGASAWA M.D.

Table of content: LLOYD STUART NAGASAWA M.D. (NPI 1487647335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487647335 NPI number — LLOYD STUART NAGASAWA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAGASAWA
Provider First Name:
LLOYD
Provider Middle Name:
STUART
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487647335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24953 PASEO DE VALENCIA
Provider Second Line Business Mailing Address:
#25B
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653-4342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-770-8168
Provider Business Mailing Address Fax Number:
949-770-2991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26691 PLAZA
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-6329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-347-0600
Provider Business Practice Location Address Fax Number:
949-347-0746
Provider Enumeration Date:
08/25/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  G50164 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)