Healthcare Provider Details

I. General information

NPI: 1578486593
Provider Name (Legal Business Name): TRITIA NISHIKAWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 LUCRETIA AVE
SAN JOSE CA
95122-3812
US

IV. Provider business mailing address

22 S 15TH ST
SAN JOSE CA
95112-2024
US

V. Phone/Fax

Practice location:
  • Phone: 408-283-6325
  • Fax:
Mailing address:
  • Phone: 408-335-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP17204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: