Basic Information
| Provider Information | |||||||||
| NPI: | 1417485087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATAMIYA | ||||||||
| FirstName: | NICOLAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 BERRY STREET LOBBY 1 | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155146429 | ||||||||
| FaxNumber: | 4155142998 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 15TH ST STE 2100 | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904041101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103191234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2017 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 20A16777 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.