Healthcare Provider Details

I. General information

NPI: 1790335958
Provider Name (Legal Business Name): MIDORI TOKUDA PIMENTEL-MILLADO CHIROPRACTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 HARBOR BLVD STE A&B
COSTA MESA CA
92626-3950
US

IV. Provider business mailing address

2960 HARBOR BLVD STE A&B
COSTA MESA CA
92626-3950
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-1947
  • Fax: 714-546-1960
Mailing address:
  • Phone: 714-546-1947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC27280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: