Healthcare Provider Details

I. General information

NPI: 1386396943
Provider Name (Legal Business Name): NIMISHA THAKKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 DEL AMO BLVD
TORRANCE CA
90503-1637
US

IV. Provider business mailing address

3565 DEL AMO BLVD
TORRANCE CA
90503-1637
US

V. Phone/Fax

Practice location:
  • Phone: 310-214-0811
  • Fax:
Mailing address:
  • Phone: 310-214-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95018213
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95018213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: