Healthcare Provider Details

I. General information

NPI: 1235531252
Provider Name (Legal Business Name): ELIZABETH HILL NISHIMURA M.S.W., A.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD SUITE 100
PASADENA CA
91107-6622
US

IV. Provider business mailing address

2555 E COLORADO BLVD SUITE 100
PASADENA CA
91107-6622
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2261
  • Fax:
Mailing address:
  • Phone: 626-577-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW63156
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW63156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: