Provider Demographics
NPI:1326744699
Name:NISHIMURA, MIMI
Entity Type:Individual
Prefix:
First Name:MIMI
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 1:840 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2430
Mailing Address - Country:US
Mailing Address - Phone:323-533-2663
Mailing Address - Fax:
Practice Address - Street 1:840 PERRY AVE
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2430
Practice Address - Country:US
Practice Address - Phone:323-533-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician