Provider Demographics
NPI:1235170440
Name:HIMMELVO, JANE THU (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:THU
Last Name:HIMMELVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 NELLIE CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-5132
Mailing Address - Country:US
Mailing Address - Phone:213-841-4181
Mailing Address - Fax:
Practice Address - Street 1:5131 NELLIE CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-5132
Practice Address - Country:US
Practice Address - Phone:213-841-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2180207Q00000X
CAA95816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI64896Medicare UPIN