Healthcare Provider Details

I. General information

NPI: 1649284993
Provider Name (Legal Business Name): HA TI BICH HOANG NISHIHARA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA NISHIHARA N.P.

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N 1ST ST STE 165
FRESNO CA
93726-6818
US

IV. Provider business mailing address

PO BOX 25880
FRESNO CA
93729-5880
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-2000
  • Fax: 559-226-5761
Mailing address:
  • Phone: 559-431-8900
  • Fax: 559-431-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: