Provider Demographics
NPI:1508329236
Name:VIGO- OH, HIMENO TAMURA (LAC)
Entity Type:Individual
Prefix:
First Name:HIMENO
Middle Name:TAMURA
Last Name:VIGO- OH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10435 LINDLEY AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3547
Mailing Address - Country:US
Mailing Address - Phone:818-266-4957
Mailing Address - Fax:
Practice Address - Street 1:10435 LINDLEY AVE APT 201
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-3547
Practice Address - Country:US
Practice Address - Phone:818-266-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18508171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist