Basic Information
| Provider Information | |||||||||
| NPI: | 1043391576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTOS | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | MIEKO-HIROKANE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HIROKANE | ||||||||
| OtherFirstName: | JANE | ||||||||
| OtherMiddleName: | MIEKO | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | JERRY L PETTIS VETERANS HOSPITAL; MEDICAL SERVICE 111D | ||||||||
| Address2: | 11201 BENTON AVENUE | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923571000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
| FaxNumber: | 9097773225 | ||||||||
| Practice Location | |||||||||
| Address1: | JERRY L PETTIS VETERANS HOSPITAL; MEDICAL SERVICE 111D | ||||||||
| Address2: | 11201 BENTON AVENUE | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923571000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
| FaxNumber: | 9097773225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | G72102 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.