MEDICARE: DR. MIDORI NISHIDA N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	ND-150	CA

General Provider Information

NPI Number	:	1548553290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIDORI NISHIDA N.D.

Provider Business Mailing Address
First Line	:	2716 OCEAN PARK BLVD STE 1063
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5227
Country	:	US
Telephone Number	:	310-450-8062
Fax Number	:

Provider Business Practice Location Address
First Line	:	2716 OCEAN PARK BLVD STE 1063
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5227
Country	:	US
Telephone Number	:	310-450-8062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	05/26/2011

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