Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A82125 | CA |
N | 2080P0203X | Pediatric Critical Care Doctor | A82125 | CA |
NPI | 1023194495 |
---|---|
Provider Name | Lance Toshio Tomooka |
First Address | Visalia, CA 93291-8222 |
Second Address | Visalia, CA 93291-8222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2006 |
Last Update Date | 03/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A821250 | (05) | CA |
H83080 | (02) |