Provider Demographics
NPI:1689878969
Name:JANOWSKI, MARK CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHARLES
Last Name:JANOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5030 CAMINO DE LA SIESTA
Mailing Address - Street 2:#208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3116
Mailing Address - Country:US
Mailing Address - Phone:619-260-6300
Mailing Address - Fax:619-260-6313
Practice Address - Street 1:5030 CAMINO DE LA SIESTA
Practice Address - Street 2:#208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3116
Practice Address - Country:US
Practice Address - Phone:619-260-6300
Practice Address - Fax:619-260-6313
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA86276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine