Active NPI
Laura Imanaka
- Pharmacist
- Modesto, CA
National Provider Identifier
1609151059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 64230
- Practice address
- 3500 Coffee Rd
Modesto, CA 95355-1305 - Phone
- (209) 341-0814
- NPI assigned
- Oct 17, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 64230 | CA | Primary |
Addresses
Primary practice location
3500 Coffee Rd
Modesto, CA 95355-1305
Mailing address
5800 Eisenhower Dr
Riverbank, CA 95367-3866
Phone (209) 596-3151
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 |
|---|---|---|---|
| 64230 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318809600000",
"number": "1609151059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5800 EISENHOWER DR",
"city": "RIVERBANK",
"state": "CA",
"postal_code": "953673866",
"telephone_number": "209-596-3151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 COFFEE RD",
"city": "MODESTO",
"state": "CA",
"postal_code": "953551305",
"telephone_number": "209-341-0814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMANAKA",
"first_name": "LAURA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-17",
"last_updated": "2011-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "64230",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.