Provider Demographics
NPI:1518282128
Name:RAO, NISHANT A (ND)
Entity Type:Individual
Prefix:DR
First Name:NISHANT
Middle Name:A
Last Name:RAO
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 KILDONAN DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1160
Mailing Address - Country:US
Mailing Address - Phone:818-281-8877
Mailing Address - Fax:
Practice Address - Street 1:305 N COAST HWY STE P
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-1681
Practice Address - Country:US
Practice Address - Phone:949-715-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-405175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath