MEDICARE: SYDNEY NISHIDA

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1902300999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY NISHIDA

Provider Business Mailing Address
First Line	:	1968 S COAST HWY # 2862
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3681
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 S COAST HWY # 2862
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3681
Country	:	US
Telephone Number	:	714-732-9186
Fax Number	:

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

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	05/12/2026

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Directions to “ SYDNEY NISHIDA ” Practice Location

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