Provider Demographics
NPI:1043391576
Name:CANTOS, JANE MIEKO-HIROKANE
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:MIEKO-HIROKANE
Last Name:CANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:MIEKO
Other - Last Name:HIROKANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:JERRY L PETTIS VETERANS HOSPITAL; MEDICAL SERVICE 111D
Mailing Address - Street 2:11201 BENTON AVENUE
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92357-1000
Mailing Address - Country:US
Mailing Address - Phone:909-825-7084
Mailing Address - Fax:909-777-3225
Practice Address - Street 1:JERRY L PETTIS VETERANS HOSPITAL; MEDICAL SERVICE 111D
Practice Address - Street 2:11201 BENTON AVENUE
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-1000
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-777-3225
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72102207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology