Provider Demographics
NPI:1447833991
Name:ISHISAKA, MIKA
Entity type:Individual
Prefix:
First Name:MIKA
Middle Name:
Last Name:ISHISAKA
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 1:7783 SLEEPY RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4483
Mailing Address - Country:US
Mailing Address - Phone:916-396-1353
Mailing Address - Fax:
Practice Address - Street 1:412 MALCOLM DR STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6174
Practice Address - Country:US
Practice Address - Phone:410-751-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist