Provider Demographics
NPI:1215023957
Name:SHIGEHARA, JANICE H (RD, CDE)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:H
Last Name:SHIGEHARA
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15004 INNOVATION DR
Mailing Address - Street 2:ROOM 2126
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3491
Mailing Address - Country:US
Mailing Address - Phone:858-554-8571
Mailing Address - Fax:858-626-7111
Practice Address - Street 1:15004 INNOVATION DR
Practice Address - Street 2:ROOM 2126
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3491
Practice Address - Country:US
Practice Address - Phone:858-554-8571
Practice Address - Fax:858-626-7111
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
710000061OtherRAILROAD MEDIICARE
CAWNT343248AMedicare PIN
CAP45582Medicare UPIN