Provider Demographics
NPI:1396171435
Name:SAKAKURA-CLARK, NYLA NAOMI (MSHS, LVN, CCDS)
Entity type:Individual
Prefix:MRS
First Name:NYLA
Middle Name:NAOMI
Last Name:SAKAKURA-CLARK
Suffix:
Gender:F
Credentials:MSHS, LVN, CCDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 MISSION ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2911
Mailing Address - Country:US
Mailing Address - Phone:415-597-8052
Mailing Address - Fax:415-597-8204
Practice Address - Street 1:982 MISSION ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2911
Practice Address - Country:US
Practice Address - Phone:415-597-8052
Practice Address - Fax:415-597-8004
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263547164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse