Provider Demographics
NPI:1609087220
Name:DARMITZEL, JANE KAZUMI
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:KAZUMI
Last Name:DARMITZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:KAZUMI
Other - Last Name:SHIMAMOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5098 BARRON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2903
Mailing Address - Country:US
Mailing Address - Phone:408-226-2107
Mailing Address - Fax:
Practice Address - Street 1:15495 LOS GATOS BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2544
Practice Address - Country:US
Practice Address - Phone:408-356-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics