Individual
MARK H NISHIKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 N CALIFORNIA ST, STOCKTON, CA 95204-6019
(209) 943-2000
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
G56041
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
G56041
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14573885890
—
CA
01
—
AY850Z
CA MEDICARE
CA
01
—
G56041
STATE LICENCE
CA
Enumeration date
07/10/2006
Last updated
04/03/2024
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