Provider Demographics
NPI:1487897120
Name:NAKAMIZO-MUKASA, TOMOKO (MA)
Entity type:Individual
Prefix:MRS
First Name:TOMOKO
Middle Name:
Last Name:NAKAMIZO-MUKASA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:TOMOKO
Other - Middle Name:NAKAMIZO
Other - Last Name:MUKASA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:18350 MOUNT LANGLEY ST
Mailing Address - Street 2:#105
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6900
Mailing Address - Country:US
Mailing Address - Phone:714-965-2324
Mailing Address - Fax:714-965-2684
Practice Address - Street 1:18350 MOUNT LANGLEY ST
Practice Address - Street 2:#105
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6900
Practice Address - Country:US
Practice Address - Phone:714-965-2324
Practice Address - Fax:714-965-2684
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP15031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist