MEDICARE: ALICIA NAOMI NISHIOKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95009492	CA

General Provider Information

NPI Number	:	1689132771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA NAOMI NISHIOKA

Provider Business Mailing Address
First Line	:	5950 BRAYTON AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4260
Country	:	US
Telephone Number	:	310-347-7672
Fax Number	:

Provider Business Practice Location Address
First Line	:	5950 BRAYTON AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4260
Country	:	US
Telephone Number	:	310-347-7672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

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Directions to “ ALICIA NAOMI NISHIOKA ” Practice Location

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