Healthcare Provider Details

I. General information

NPI: 1992205926
Provider Name (Legal Business Name): JOHN FUJIWARA FNP-C PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 09/10/2022
Certification Date: 09/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S SAN PEDRO ST STE 302
LOS ANGELES CA
90012-5308
US

IV. Provider business mailing address

200 S SAN PEDRO ST STE 302
LOS ANGELES CA
90012-5308
US

V. Phone/Fax

Practice location:
  • Phone: 213-680-0355
  • Fax: 323-980-4848
Mailing address:
  • Phone: 213-680-0355
  • Fax: 323-980-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95122533
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: