Healthcare Provider Details

I. General information

NPI: 1861349425
Provider Name (Legal Business Name): MOMOKA NAKAMURA NISHINO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2572 ATLANTIC AVE
LONG BEACH CA
90806-2751
US

IV. Provider business mailing address

3612 W ESTATES LN UNIT E
ROLLING HILLS ESTATES CA
90274-4147
US

V. Phone/Fax

Practice location:
  • Phone: 888-606-0911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number950378019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: