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NPI Code Detail

MEDICARE: JANICE H. SHIGEHARA R.D., C.D.E.

MEDICARE: JANICE H. SHIGEHARA R.D., C.D.E.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian343248CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1710000061OTHERRAILROAD MEDIICARE

General Provider Information

NPI Number : 1215023957
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE H. SHIGEHARA R.D., C.D.E.
Provider Business Mailing Address
First Line : 15004 INNOVATION DR
Second Line : ROOM 2126
City : SAN DIEGO
State : CA
Zip : 92128-3491
Country : US
Telephone Number : 858-554-8571
Fax Number : 858-626-7111
Provider Business Practice Location Address
First Line : 15004 INNOVATION DR
Second Line : ROOM 2126
City : SAN DIEGO
State : CA
Zip : 92128-3491
Country : US
Telephone Number : 858-554-8571
Fax Number : 858-626-7111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 09/23/2011

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