Healthcare Provider Details

I. General information

NPI: 1114834496
Provider Name (Legal Business Name): CARL RIKIO NISHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DANVILLE BLVD
DANVILLE CA
94526-2404
US

IV. Provider business mailing address

501 DANVILLE BLVD
DANVILLE CA
94526-2404
US

V. Phone/Fax

Practice location:
  • Phone: 925-552-5503
  • Fax:
Mailing address:
  • Phone: 925-552-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number107384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: