Provider Demographics
NPI:1083641872
Name:SHISHIDO, SHIZUKA ERIN (MPAS, PA-C, ATC,CSCS)
Entity type:Individual
Prefix:MS
First Name:SHIZUKA
Middle Name:ERIN
Last Name:SHISHIDO
Suffix:
Gender:F
Credentials:MPAS, PA-C, ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20911 EARL ST
Mailing Address - Street 2:#470
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4352
Mailing Address - Country:US
Mailing Address - Phone:310-372-0700
Mailing Address - Fax:
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:#470
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-372-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21497363A00000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer