Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A101076 | CA |
N | 208000000X | Pediatrician | M-1938 | GU |
N | 2080P0203X | Pediatric Critical Care Doctor | A101076 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | M-1938 | GU |
NPI | 1134334600 |
---|---|
Provider Name | Dr. Kozue Shimabukuro |
First Address | Loma Linda, CA 92350-1700 |
Second Address | Loma Linda, CA 92350-1700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 11/02/2022 |