MEDICARE: MR. JAMES ITO MD

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
1	207R00000X	Internal Medicine Physician	G30381	CA
2	207RI0200X	Infectious Disease Physician	G30381	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427165463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ITO MD

Provider Business Mailing Address
First Line	:	7343 EL NIDO
Second Line	:
City	:	LA VERNE
State	:	CA
Zip	:	91750-1127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7343 EL NIDO
Second Line	:
City	:	LA VERNE
State	:	CA
Zip	:	91750-1127
Country	:	US
Telephone Number	:	909-596-7245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	08/07/2019

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