Individual provider Active NPI

Robert Joesph Wakamatsu, D.C.

  • Chiropractor
  • Encino, CA
National Provider Identifier
1043355209
Registry record updated Nov 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
16926 Issued in CA
Practice address
17552 Ventura Blvd
Encino, CA 91316-3835
Phone
(818) 788-5504
Fax
(818) 386-1005
NPI assigned
Feb 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 16926 CA Primary

Addresses

Primary practice location

17552 Ventura Blvd
Encino, CA 91316-3835

Mailing address

17552 Ventura Blvd
Encino, CA 91316-3835
Phone (818) 788-5504

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
16926CAMDOccupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257206400000",
    "number": "1043355209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17552 VENTURA BLVD",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913163835",
            "telephone_number": "818-788-5504",
            "fax_number": "818-386-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17552 VENTURA BLVD",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913163835",
            "telephone_number": "818-788-5504",
            "fax_number": "818-386-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKAMATSU",
        "first_name": "ROBERT",
        "middle_name": "JOESPH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2009-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "16926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.