Provider Demographics
NPI:1679790281
Name:NAGAMOTO, ALAN
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:NAGAMOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCLA STUDENT PSYCHOLOGICAL SERVICES
Mailing Address - Street 2:JOHN WOODEN CENTER WEST 221 WESTWOOD PLAZA
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UCLA STUDENT PSYCHOLOGICAL SERVICES
Practice Address - Street 2:JOHN WOODEN CENTER WEST 221 WESTWOOD PLAZA
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1556
Practice Address - Country:US
Practice Address - Phone:310-825-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7774103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical