Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A82481 | CA |
NPI | 1053382044 |
---|---|
Provider Name | Dr. Charlene Vimala Kakimoto |
First Address | Coronado, CA 92118-1978 |
Second Address | Coronado, CA 92118-1978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 27/09/2013 |