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General NPI Number Information
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NPI Number | 1417153735
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Entity Type | Organization
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Legal Business Name | HERBERT M JANKLOW, MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/23/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 3615 SAGUNTO ST
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City | SANTA YNEZ
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State | CA
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Zip | 93460-9577
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Country | US
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Telephone | 805-688-6171
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 732
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City | SANTA YNEZ
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State | CA
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Zip | 93460-0732
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HERBERT JANKLOW
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Credential | MD
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Telephone | 805-688-6171
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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 | G11196
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License Number State | CA
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