Provider Demographics
NPI:1003243262
Name:NISHIMURA, MARIN
Entity Type:Individual
Prefix:
First Name:MARIN
Middle Name:
Last Name:NISHIMURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S PIERCE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4124
Mailing Address - Country:US
Mailing Address - Phone:619-668-4700
Mailing Address - Fax:619-668-0049
Practice Address - Street 1:300 S PIERCE ST STE 201
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4124
Practice Address - Country:US
Practice Address - Phone:619-668-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine