Provider Demographics
NPI:1639450703
Name:IKEZAKI, MARGARET
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
Last Name:IKEZAKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10765 WOODSIDE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-8103
Mailing Address - Country:US
Mailing Address - Phone:619-456-9609
Mailing Address - Fax:
Practice Address - Street 1:10765 WOODSIDE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-8103
Practice Address - Country:US
Practice Address - Phone:619-456-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator