Provider Demographics
NPI:1215928171
Name:MITSUOKA, JEVON CHRIS (PHARMD, PA-C)
Entity type:Individual
Prefix:DR
First Name:JEVON
Middle Name:CHRIS
Last Name:MITSUOKA
Suffix:
Gender:M
Credentials:PHARMD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29351 MADEIRA LN
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1598
Mailing Address - Country:US
Mailing Address - Phone:661-775-7737
Mailing Address - Fax:
Practice Address - Street 1:29351 MADEIRA LN
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1598
Practice Address - Country:US
Practice Address - Phone:661-775-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51802183500000X
CA17474363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No183500000XPharmacy Service ProvidersPharmacist