Provider Demographics
NPI:1548553290
Name:NISHIDA, MIDORI (ND)
Entity type:Individual
Prefix:DR
First Name:MIDORI
Middle Name:
Last Name:NISHIDA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 OCEAN PARK BLVD STE 1063
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5227
Mailing Address - Country:US
Mailing Address - Phone:310-450-8062
Mailing Address - Fax:
Practice Address - Street 1:2716 OCEAN PARK BLVD STE 1063
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5227
Practice Address - Country:US
Practice Address - Phone:310-450-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-150175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath