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General NPI Number Information
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NPI Number | 1437817434
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Entity Type | Organization
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Legal Business Name | JOHN FUJIWARA NP-C PMHNP-BC LLC
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 8275 S EASTERN AVE STE 200-175
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City | LAS VEGAS
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State | NV
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Zip | 89123-2591
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Country | US
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Telephone | 702-758-4708
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Fax |
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Provider Business Mailing Address
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Address Line | 877 ROANOKE RD
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City | SAN MARINO
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State | CA
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Zip | 91108-2437
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Country | US
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Telephone | 626-348-4458
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PROVIDER
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Name | JOHN FUJIWARA
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Credential | NP-C PMHNP-BC
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Telephone | 702-758-4708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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