Provider Demographics
NPI:1639448996
Name:NISHIYAMA, RACHEL GAIL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:GAIL
Last Name:NISHIYAMA
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 1:510 WYCLIFFE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1213
Mailing Address - Country:US
Mailing Address - Phone:925-989-6447
Mailing Address - Fax:
Practice Address - Street 1:4482 BARRANCA PKWY STE 195
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4706
Practice Address - Country:US
Practice Address - Phone:949-679-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist