Provider Demographics
NPI:1912511403
Name:PATOLIA, NISHITA RASIK (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:NISHITA
Middle Name:RASIK
Last Name:PATOLIA
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S CATALINA AVE STE L70
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5296
Mailing Address - Country:US
Mailing Address - Phone:310-316-1954
Mailing Address - Fax:
Practice Address - Street 1:1611 S CATALINA AVE STE L70
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5296
Practice Address - Country:US
Practice Address - Phone:310-316-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015188363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner