Provider Demographics
NPI:1841174992
Name:HITOMI, NICOLE TAKAKO (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TAKAKO
Last Name:HITOMI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 YGNACIO WOODS CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2203
Mailing Address - Country:US
Mailing Address - Phone:925-818-0064
Mailing Address - Fax:
Practice Address - Street 1:3770 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2527
Practice Address - Country:US
Practice Address - Phone:951-352-3937
Practice Address - Fax:951-352-2839
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA66448363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant