Provider Demographics
NPI:1679537229
Name:HOSOHAMA, BETTY MISA (MD)
Entity Type:Individual
Prefix:
First Name:BETTY MISA
Middle Name:
Last Name:HOSOHAMA
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 1:627 BRUNKEN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-5002
Mailing Address - Country:US
Mailing Address - Phone:831-796-3740
Mailing Address - Fax:
Practice Address - Street 1:559 ABBOTT ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4325
Practice Address - Country:US
Practice Address - Phone:831-775-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA638992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A638990Medicaid
CAH39371Medicare UPIN
CA00A638990Medicaid