Provider Demographics
NPI:1487647335
Name:NAGASAWA, LLOYD STUART (MD)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:STUART
Last Name:NAGASAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:#25B
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4342
Mailing Address - Country:US
Mailing Address - Phone:949-770-8168
Mailing Address - Fax:949-770-2991
Practice Address - Street 1:26691 PLAZA
Practice Address - Street 2:STE. 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6329
Practice Address - Country:US
Practice Address - Phone:949-347-0600
Practice Address - Fax:949-347-0746
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG50164207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51585Medicare UPIN
CAG50164Medicare PIN