Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A62708 | CA |
NPI | 1225087984 |
---|---|
Provider Name | Dr. Robert S Nishime |
First Address | Santa Clara, CA 95050-4966 |
Second Address | San Jose, CA 95112-3256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 26/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A627080 | (05) | CA |
G84323 | (02) | CA |