Healthcare Provider Details

I. General information

NPI: 1194756072
Provider Name (Legal Business Name): HERBERT MICHAEL JANKLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 SAGUNTO ST
SANTA YNEZ CA
93460-9577
US

IV. Provider business mailing address

PO BOX 732
SANTA YNEZ CA
93460-0732
US

V. Phone/Fax

Practice location:
  • Phone: 805-688-6171
  • Fax:
Mailing address:
  • Phone: 805-688-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG11196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: