Healthcare Provider Details

I. General information

NPI: 1134060221
Provider Name (Legal Business Name): SUSANE MORAN NISHIKAWA M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S RANCHO SANTA FE RD
ENCINITAS CA
92024-4349
US

IV. Provider business mailing address

2646 LEVANTE ST
CARLSBAD CA
92009-8118
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-4300
  • Fax:
Mailing address:
  • Phone: 760-415-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberRPE12974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: