Provider Demographics
NPI:1225141765
Name:TANAKA, JANE CHIYOKO (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:CHIYOKO
Last Name:TANAKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15725 SNUZ MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-7331
Mailing Address - Country:US
Mailing Address - Phone:760-788-2445
Mailing Address - Fax:760-788-2494
Practice Address - Street 1:15725 SNUZ MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-7331
Practice Address - Country:US
Practice Address - Phone:760-788-2445
Practice Address - Fax:760-788-2494
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG687252084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry