Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A86728 | CA |
N | 2081P2900X | Pain Medicine | A86728 | CA |
NPI | 1174713168 |
---|---|
Provider Name | Justin Hata |
First Address | Loma Linda, CA 92354 |
Second Address | Loma Linda, CA 92354-3711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 24/05/2017 |