Individual
MR. RANDY MASAO NAKASONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
508 UNIVERSITY AVE, LAS VEGAS, NM 87701-4349
(505) 425-7762
(505) 454-9880
Mailing address
508 UNIVERSITY AVE, LAS VEGAS, NM 87701-4349
(505) 425-7762
(505) 454-9880
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1308
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1308
PT LICENSE
NM
Enumeration date
11/08/2006
Last updated
07/08/2007
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