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General NPI Number Information
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NPI Number | 1316034697
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Entity Type | Individual
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Provider Name | NISHA JOSEPH MATTATHIL PHARM D
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 39400 PASEO PADRE PKWY
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City | FREMONT
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State | CA
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Zip | 94538-2310
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Country | US
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Telephone | 510-248-7577
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Fax |
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Provider Business Mailing Address
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Address Line | 2119 CALLE VISTA VERDE
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City | MILPITAS
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State | CA
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Zip | 95035-7866
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Country | US
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Telephone | 408-956-1553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 54758
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License Number State | CA
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