Provider Demographics
NPI:1326515396
Name:NISHIDA, HARUMI
Entity Type:Individual
Prefix:
First Name:HARUMI
Middle Name:
Last Name:NISHIDA
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 1:1986 STRATTON CIR APT A
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2276
Mailing Address - Country:US
Mailing Address - Phone:773-584-2835
Mailing Address - Fax:
Practice Address - Street 1:2505 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4127
Practice Address - Country:US
Practice Address - Phone:650-988-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29675103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist