Provider Demographics
NPI:1508840349
Name:NISHIMOTO, WARREN (DO)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:NISHIMOTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 ABBOTT ST
Mailing Address - Street 2:100
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4483
Mailing Address - Country:US
Mailing Address - Phone:831-751-7070
Mailing Address - Fax:831-751-7050
Practice Address - Street 1:355 ABBOTT ST
Practice Address - Street 2:100
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4483
Practice Address - Country:US
Practice Address - Phone:831-751-7070
Practice Address - Fax:831-751-7050
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF86516Medicare UPIN