Provider Demographics
NPI:1194994061
Name:SHIRAISHI, NOBUYUKI (NMT MT-BC LCAT)
Entity type:Individual
Prefix:
First Name:NOBUYUKI
Middle Name:
Last Name:SHIRAISHI
Suffix:
Gender:M
Credentials:NMT MT-BC LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-0471
Mailing Address - Country:US
Mailing Address - Phone:559-935-3186
Mailing Address - Fax:
Practice Address - Street 1:400 W FOREST AVE APT 114
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-2566
Practice Address - Country:US
Practice Address - Phone:979-665-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist