Provider Demographics
NPI:1740527274
Name:NISHIMOTO, JEREMY
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:NISHIMOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4006
Mailing Address - Country:US
Mailing Address - Phone:714-795-3444
Mailing Address - Fax:714-795-3445
Practice Address - Street 1:615 W CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4006
Practice Address - Country:US
Practice Address - Phone:714-795-3444
Practice Address - Fax:714-795-3445
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor