Provider Demographics
NPI:1790335958
Name:PIMENTEL-MILLADO, MIDORI TOKUDA (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:MIDORI
Middle Name:TOKUDA
Last Name:PIMENTEL-MILLADO
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 HARBOR BLVD STE A&B
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3950
Mailing Address - Country:US
Mailing Address - Phone:714-546-1947
Mailing Address - Fax:
Practice Address - Street 1:2960 HARBOR BLVD STE A&B
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3950
Practice Address - Country:US
Practice Address - Phone:714-546-1947
Practice Address - Fax:714-546-1960
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27280111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation