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General NPI Number Information
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NPI Number | 1518435551
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Entity Type | Organization
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Legal Business Name | MITCHELL M NISHIMOTO MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 15243 VANOWEN ST STE 408
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City | VAN NUYS
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State | CA
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Zip | 91405-3658
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Country | US
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Telephone | 818-785-3889
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Fax | 818-782-1227
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Provider Business Mailing Address
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Address Line | 15243 VANOWEN ST STE 406
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City | VAN NUYS
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State | CA
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Zip | 91405-3655
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Country | US
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Telephone | 818-785-3889
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Fax | 818-782-1227
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Authorized Official
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Title or Position | PRESIDENT
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Name | MITCHELL NISHIMOTO
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Credential |
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Telephone | 818-785-3889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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