Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | G86074 | CA |
NPI | 1184642605 |
---|---|
Provider Name | Garret Hisatake |
First Address | Sacramento, CA 95865-4947 |
Second Address | San Francisco, CA 94115-1932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 26/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H38594 | (02) | CA |