Healthcare Provider Details

I. General information

NPI: 1487621801
Provider Name (Legal Business Name): ROBERT TADASHI HATANAKA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N PACIFIC AVE STE 104
GLENDALE CA
91202
US

IV. Provider business mailing address

1101 N PACIFIC AVE STE 104
GLENDALE CA
91202
US

V. Phone/Fax

Practice location:
  • Phone: 818-552-5000
  • Fax: 818-552-2959
Mailing address:
  • Phone: 818-552-5000
  • Fax: 818-552-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: