Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G72102 | CA |
NPI | 1043391576 |
---|---|
Provider Name | Mrs. Jane Mieko-Hirokane Cantos |
First Address | Loma Linda, CA 92357-1000 |
Second Address | Loma Linda, CA 92357-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |