Provider Demographics
NPI:1649284993
Name:HOANG NISHIHARA, HA TI BICH (NP)
Entity type:Individual
Prefix:MRS
First Name:HA
Middle Name:TI BICH
Last Name:HOANG NISHIHARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:NISHIHARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 25880
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5880
Mailing Address - Country:US
Mailing Address - Phone:559-431-8900
Mailing Address - Fax:559-431-4367
Practice Address - Street 1:3636 N 1ST ST STE 165
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6818
Practice Address - Country:US
Practice Address - Phone:559-225-2000
Practice Address - Fax:559-226-5761
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089961Medicaid
CAS87150Medicare UPIN
CAZZZ20843ZMedicare ID - Type Unspecified