Healthcare Provider Details

I. General information

NPI: 1689071045
Provider Name (Legal Business Name): NAMIKO NERIO, DO, MS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21530 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2608
US

IV. Provider business mailing address

455 E OCEAN BLVD APT 1017
LONG BEACH CA
90802-4944
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-0401
  • Fax:
Mailing address:
  • Phone: 310-383-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11989
License Number StateCA

VIII. Authorized Official

Name: N NERIO
Title or Position: CEO
Credential: DO
Phone: 310-383-5243