Provider Demographics
NPI:1992170351
Name:OKUMA, LUCAS HISASHI (ATC)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:HISASHI
Last Name:OKUMA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ALMOND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-2206
Mailing Address - Country:US
Mailing Address - Phone:650-960-8887
Mailing Address - Fax:
Practice Address - Street 1:201 ALMOND AVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-2206
Practice Address - Country:US
Practice Address - Phone:650-960-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2000014282172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker