Provider Demographics
NPI:1255431896
Name:NISHIJIMA, ROSS M (DPM)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:M
Last Name:NISHIJIMA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 W BULLARD AVE
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-7611
Mailing Address - Country:US
Mailing Address - Phone:559-298-3668
Mailing Address - Fax:559-298-5298
Practice Address - Street 1:200 W BULLARD AVE
Practice Address - Street 2:SUITE D-2
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-7611
Practice Address - Country:US
Practice Address - Phone:559-298-3668
Practice Address - Fax:559-298-5298
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3043213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA480005402Medicare PIN
CA000E30430Medicare PIN
CAT11560Medicare UPIN
CA4688960001Medicare NSC