1619065414 NPI number — MR. BRUCE K AKINAKA PT, ATC, HEALTH CERT

Table of content: MR. BRUCE K AKINAKA PT, ATC, HEALTH CERT (NPI 1619065414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619065414 NPI number — MR. BRUCE K AKINAKA PT, ATC, HEALTH CERT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AKINAKA
Provider First Name:
BRUCE
Provider Middle Name:
K
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT, ATC, HEALTH CERT
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:
1619065414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3038 CAYENTE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMERON PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95682-8879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-677-0406
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 CEDAR RAVINE RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-6561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-626-2770
Provider Business Practice Location Address Fax Number:
530-622-7143
Provider Enumeration Date:
10/10/2006

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: 174400000X , with the licence number:  PT10876 , 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)

  • Identifier: PT10876 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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