Healthcare Provider Details

I. General information

NPI: 1629972807
Provider Name (Legal Business Name): MARGARITA MIYASATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3581 PALMER DR STE 400
CAMERON PARK CA
95682-8237
US

IV. Provider business mailing address

3420 ROSEBUD DR
SHINGLE SPRINGS CA
95682-8789
US

V. Phone/Fax

Practice location:
  • Phone: 415-297-8303
  • Fax:
Mailing address:
  • Phone: 415-297-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number78906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: