Healthcare Provider Details

I. General information

NPI: 1902960370
Provider Name (Legal Business Name): RICH NAKANISHI MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SW OAK ST SUITE 520
PORTLAND OR
97204-1817
US

IV. Provider business mailing address

421 SW OAK ST SUITE 520
PORTLAND OR
97204-1817
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5464
  • Fax:
Mailing address:
  • Phone: 503-988-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: