Most Relevant Information
Provider Data
| NPI Number: | 1003308487 |
| Provider Name: | KIMBERLY NISHIYAMA DTR |
| Entity Type: | Individual |
| Taxonomy Code: | 136A00000X |
| Specialty: | Dietetic Technician, Registered |
| License Number: | 86092429 |
Most Important Dates
| Enumeration Date: | 06/01/2018 |
| Last Updated: | 06/01/2018 |
Provider Practice Location
20325 N 51ST AVE
GLENDALE
AZ
853085674
Practice Location Phone/Fax
| Phone: | 6023415248 |
| Fax: |
Provider Mailing Location
20325 N 51ST AVE STE 166
GLENDALE
AZ
853084624
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |