Provider Demographics
NPI:1053875740
Name:NISHIYAMA, JANICE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:NISHIYAMA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 WILSHIRE BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3204
Mailing Address - Country:US
Mailing Address - Phone:424-262-1450
Mailing Address - Fax:
Practice Address - Street 1:2200 PACIFIC COAST HWY STE 207
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2701
Practice Address - Country:US
Practice Address - Phone:424-262-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16545103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist