Healthcare Provider Details

I. General information

NPI: 1275677585
Provider Name (Legal Business Name): ESTHER RO ISHITANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 ROSEMEAD BLVD FL 2
EL MONTE CA
91731-2830
US

IV. Provider business mailing address

1249 S DIAMOND BAR BLVD # 213
DIAMOND BAR CA
91765-4122
US

V. Phone/Fax

Practice location:
  • Phone: 626-227-7014
  • Fax: 626-227-7015
Mailing address:
  • Phone: 323-810-2604
  • Fax: 626-227-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA74330
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA74330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: