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General NPI Number Information
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NPI Number | 1043391576
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Entity Type | Individual
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Provider Name | MRS. JANE MIEKO-HIROKANE CANTOS
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Gender | Female
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | JERRY L PETTIS VETERANS HOSPITAL; MEDICAL SERVICE 111D 11201 BENTON AVENUE
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City | LOMA LINDA
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State | CA
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Zip | 92357-1000
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Country | US
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Telephone | 909-825-7084
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Fax | 909-777-3225
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Provider Business Mailing Address
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Address Line | JERRY L PETTIS VETERANS HOSPITAL; MEDICAL SERVICE 111D 11201 BENTON AVENUE
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City | LOMA LINDA
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State | CA
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Zip | 92357-1000
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Country | US
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Telephone | 909-825-7084
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Fax | 909-777-3225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G72102
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License Number State | CA
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