Active NPI
Patrick Imamura
- Mental Health Counselor
- Gardena, CA
National Provider Identifier
1124483797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- ASW63238
- Practice address
- 108 W Victoria St
Gardena, CA 90248-3523 - Phone
- (310) 715-2020
- NPI assigned
- Dec 23, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | ASW63238 | CA | Primary |
Addresses
Primary practice location
108 W Victoria St
Gardena, CA 90248-3523
Mailing address
13510 Droxford St
Cerritos, CA 90703-6332
Phone (562) 405-9590
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
| License | State | Type | Specialty |
|---|---|---|---|
| ASW63238 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450828800000",
"number": "1124483797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13510 DROXFORD ST",
"city": "CERRITOS",
"state": "CA",
"postal_code": "907036332",
"telephone_number": "562-405-9590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 W VICTORIA ST",
"city": "GARDENA",
"state": "CA",
"postal_code": "902483523",
"telephone_number": "310-715-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMAMURA",
"first_name": "PATRICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-12-23",
"last_updated": "2015-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ASW63238",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.