Provider Demographics
NPI:1689663486
Name:KANDO, JANICE (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:KANDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4200 MEADOWLARK LN SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1050
Mailing Address - Country:US
Mailing Address - Phone:505-891-9990
Mailing Address - Fax:505-891-9007
Practice Address - Street 1:4200 MEADOWLARK LN SE
Practice Address - Street 2:SUITE 2
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1050
Practice Address - Country:US
Practice Address - Phone:505-891-9990
Practice Address - Fax:505-891-9007
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM92-263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME96712Medicare UPIN
NM343501305Medicare ID - Type Unspecified